Provider Demographics
NPI:1841611746
Name:MCGOUGAN, DAVA M (DNP)
Entity Type:Individual
Prefix:MS
First Name:DAVA
Middle Name:M
Last Name:MCGOUGAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:DAVA
Other - Middle Name:M
Other - Last Name:CARNAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:3009 N BALLAS RD STE 383C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2324
Mailing Address - Country:US
Mailing Address - Phone:314-996-4545
Mailing Address - Fax:314-996-4546
Practice Address - Street 1:3009 N BALLAS RD STE 383C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2324
Practice Address - Country:US
Practice Address - Phone:314-996-4545
Practice Address - Fax:314-996-4546
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013037722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily