Healthcare Provider Details

I. General information

NPI: 1811202146
Provider Name (Legal Business Name): LAUREN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE STE 280A
SAINT LOUIS MO
63117-1818
US

IV. Provider business mailing address

1008 S SPRING AVE FL 1
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2110
  • Fax: 314-617-2113
Mailing address:
  • Phone: 314-617-3393
  • Fax: 314-617-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2016013882
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: