Provider Demographics
NPI:1225513492
Name:MEUTH, RACHAEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:E
Last Name:MEUTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:E
Other - Last Name:HARTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:520 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3845
Mailing Address - Country:US
Mailing Address - Phone:314-645-4434
Mailing Address - Fax:314-645-3801
Practice Address - Street 1:520 S ELM AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3845
Practice Address - Country:US
Practice Address - Phone:314-645-4434
Practice Address - Fax:314-645-3801
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant