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NPI Code Detail

MEDICARE: SARAH AGNES ECK WALTKE PA-C

MEDICARE: SARAH AGNES ECK WALTKE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2015012056MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22015012056OTHERMOPA LICENSE

General Provider Information

NPI Number : 1659758134
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH AGNES ECK WALTKE PA-C
Provider Business Mailing Address
First Line : 701 S NEW BALLAS RD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8726
Country : US
Telephone Number : 314-251-6710
Fax Number : 314-251-6712
Provider Business Practice Location Address
First Line : 701 S NEW BALLAS RD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8726
Country : US
Telephone Number : 314-251-6710
Fax Number : 314-251-6712
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2015
Last Update Date : 02/04/2026

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