Healthcare Provider Details

I. General information

NPI: 1316678303
Provider Name (Legal Business Name): EMILY O'MARA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 WOODMOOR RIDGE DR
WILDWOOD MO
63011-1778
US

IV. Provider business mailing address

2025 ZUMBEHL RD
SAINT CHARLES MO
63303-2723
US

V. Phone/Fax

Practice location:
  • Phone: 636-484-1248
  • Fax:
Mailing address:
  • Phone: 636-288-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018038256
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN313781
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023025357
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: