=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629969217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHAEL ANNA EATON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2025
-----------------------------------------------------
Last Update Date | 07/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12545 OLIVE BLVD
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-6311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-786-5389
-----------------------------------------------------
Fax | 314-786-5389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2012 BUTTONWOOD CT
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62062-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-581-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2014002257
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------