Healthcare Provider Details

I. General information

NPI: 1043159809
Provider Name (Legal Business Name): LAUREN DRBUL MATTINGLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12436 TESSON FERRY RD
SAINT LOUIS MO
63128-2702
US

IV. Provider business mailing address

603 LAKEWOOD DR
LAKE SAINT LOUIS MO
63367-1311
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6336
  • Fax:
Mailing address:
  • Phone: 314-599-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2026005046
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: