Provider Demographics
NPI:1710686894
Name:KOOTMAN, SARA RENEE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RENEE
Last Name:KOOTMAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:RENEE
Other - Last Name:BRODSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:927 MOREHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2157
Mailing Address - Country:US
Mailing Address - Phone:314-341-2443
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 5003B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8270
Practice Address - Country:US
Practice Address - Phone:314-251-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023005440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily