Healthcare Provider Details

I. General information

NPI: 1851911341
Provider Name (Legal Business Name): ASHLEE BROOKE ROYBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 08/08/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL, MSC 8208-0016-01
ST LOUIS MO
63110-1002
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL, MSC 8208-0016-01
ST LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2527
  • Fax: 314-747-8880
Mailing address:
  • Phone: 314-454-2527
  • Fax: 314-747-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023026708
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: