Healthcare Provider Details

I. General information

NPI: 1154895308
Provider Name (Legal Business Name): RACHEL LEE WAGSTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY # 300
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

4801 WELDON SPRING PKWY # 300
WELDON SPRING MO
63304-9101
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-5760
  • Fax: 866-440-9231
Mailing address:
  • Phone: 636-949-5760
  • Fax: 866-440-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number210302944
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: