=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033070040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH KATHLEEN SCOGGAN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6020 BROADWAY ST
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62305-7919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-224-3366
-----------------------------------------------------
Fax | 217-221-6190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6020 BROADWAY ST
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62305-7919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-224-3366
-----------------------------------------------------
Fax | 217-221-6190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2016042691
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------