Healthcare Provider Details

I. General information

NPI: 1417623828
Provider Name (Legal Business Name): SARAH ANN RUSSELL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 208
WASHINGTON MO
63090-3129
US

IV. Provider business mailing address

98 RUSSELL RD
LONEDELL MO
63060-1521
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8097
  • Fax: 636-390-7308
Mailing address:
  • Phone: 314-807-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2021042417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: