Healthcare Provider Details

I. General information

NPI: 1417871518
Provider Name (Legal Business Name): GENERATION CLINICAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MARK DR
WAHOO NE
68066-4023
US

IV. Provider business mailing address

10426 BAUR BLVD
SAINT LOUIS MO
63132-1905
US

V. Phone/Fax

Practice location:
  • Phone: 314-925-0903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAE LIN
Title or Position: EXECUTIVE DIRECTOR OF OPERATIONS
Credential:
Phone: 314-925-0903