Provider Demographics
NPI:1699043182
Name:SERINI, MEGAN L (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:L
Last Name:SERINI
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:SERINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RAGSDALE, RN
Mailing Address - Street 1:5 LACY CT
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-3405
Mailing Address - Country:US
Mailing Address - Phone:573-318-0646
Mailing Address - Fax:
Practice Address - Street 1:1027 BELLEVUE AVE STE 205
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1851
Practice Address - Country:US
Practice Address - Phone:314-768-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024166163W00000X
MO2022026309363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse