Healthcare Provider Details

I. General information

NPI: 1336003128
Provider Name (Legal Business Name): TARA MARIE CASALETTO MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 WENTZVILLE PKWY
WENTZVILLE MO
63385-3408
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-497-4060
  • Fax:
Mailing address:
  • Phone: 636-497-4060
  • Fax: 636-497-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026007963
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020006031
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: