Provider Demographics
NPI:1891194650
Name:SCAGGS, KRISTEN LEIGH (FNP BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:SCAGGS
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-4760
Mailing Address - Country:US
Mailing Address - Phone:314-251-4659
Mailing Address - Fax:314-251-5715
Practice Address - Street 1:621 S NEW BALLAS RD STE 6017B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8274
Practice Address - Country:US
Practice Address - Phone:314-251-4659
Practice Address - Fax:314-251-5715
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014016879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily