Healthcare Provider Details

I. General information

NPI: 1699608141
Provider Name (Legal Business Name): RACHEL AMBER MANNING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 4401 MERAMEC BOTTOM RD UNIT G
ST LOUIS MO
63129
US

IV. Provider business mailing address

419 TRINITY RDG
PEVELY MO
63070-1652
US

V. Phone/Fax

Practice location:
  • Phone: 314-564-9382
  • Fax:
Mailing address:
  • Phone: 314-791-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20260000531
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: