Healthcare Provider Details

I. General information

NPI: 1740694074
Provider Name (Legal Business Name): MEGHAN SULLIVAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 280
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-4415
  • Fax:
Mailing address:
  • Phone: 314-432-4415
  • Fax: 314-432-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014018618
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014018618
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: