Healthcare Provider Details

I. General information

NPI: 1326595281
Provider Name (Legal Business Name): RACHEL WILKINSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 SCHUETZ RD
SAINT LOUIS MO
63146-3538
US

IV. Provider business mailing address

11605 STUDT AVE STE 120
SAINT LOUIS MO
63141-7052
US

V. Phone/Fax

Practice location:
  • Phone: 314-625-8454
  • Fax:
Mailing address:
  • Phone: 314-625-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006025924
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017035852
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: