Healthcare Provider Details

I. General information

NPI: 1770757957
Provider Name (Legal Business Name): SHERRI LEE MCGAULEY ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY ROAD SUITE 100
ST. LOUIS MO
63122-3356
US

IV. Provider business mailing address

2325 DOUGHERTY FERRY ROAD SUITE 100
ST. LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 314-909-1359
  • Fax: 314-909-1370
Mailing address:
  • Phone: 314-909-1359
  • Fax: 314-909-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number154131
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2014036833
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: