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General NPI Number Information
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NPI Number | 1205725199
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Entity Type | Individual
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Provider Name | CARISSA MARIE REASK CPNP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 13303 TESSON FERRY RD STE 150
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City | SAINT LOUIS
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State | MO
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Zip | 63128-4066
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Country | US
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Telephone | 314-842-5239
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Fax | 314-842-3938
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Provider Business Mailing Address
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Address Line | PO BOX 419052
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City | SAINT LOUIS
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State | MO
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Zip | 63141-9052
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Country | US
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Telephone | 314-851-1000
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Fax | 314-842-3938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2025026856
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License Number State | MO
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