Healthcare Provider Details

I. General information

NPI: 1023679172
Provider Name (Legal Business Name): SARAH KRISTIN CRUDDEN FLORENCE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12125 WOODCREST EXECUTIVE DR STE 215
SAINT LOUIS MO
63141-5010
US

IV. Provider business mailing address

12125 WOODCREST EXECUTIVE DR STE 215
SAINT LOUIS MO
63141-5010
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-5366
  • Fax: 314-697-4736
Mailing address:
  • Phone: 314-626-5366
  • Fax: 314-697-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-06179
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025012232
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-10068
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: