Healthcare Provider Details

I. General information

NPI: 1013569532
Provider Name (Legal Business Name): SARAH ELIZABETH LEDNICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

4905 MEXICO RD STE 300
SAINT PETERS MO
63376-1601
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-7300
  • Fax:
Mailing address:
  • Phone: 636-928-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019024736
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: