Healthcare Provider Details

I. General information

NPI: 1750205316
Provider Name (Legal Business Name): SAMANTHA JO KREMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 WENTZVILLE PKWY
WENTZVILLE MO
63385-3407
US

IV. Provider business mailing address

14 CROOKED STICK CT
O FALLON MO
63366-5557
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2020022254
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: