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NPI Code Detail

MEDICARE: SARAH REGAN AGNP

MEDICARE:   SARAH  REGAN  AGNP
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
1363LG0600XGerontology Nurse Practitioner2019019618MO
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1922569995
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH REGAN AGNP
Provider Business Mailing Address
First Line : PO BOX 955534
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-5534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1031 BELLEVUE AVE STE 100
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1855
Country : US
Telephone Number : 314-540-8332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2019
Last Update Date : 10/26/2020

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