Healthcare Provider Details

I. General information

NPI: 1710812003
Provider Name (Legal Business Name): RACHAEL WATERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 RIDGEVIEW DR
SAINT ROBERT MO
65584-8614
US

IV. Provider business mailing address

194 RIDGEVIEW DR
SAINT ROBERT MO
65584-8614
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-6572
  • Fax:
Mailing address:
  • Phone: 805-865-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2025026066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: