Provider Demographics
NPI:1255028411
Name:SAALE, SAMANTHA APRIL (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:APRIL
Last Name:SAALE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 PIEDRAS PKWY
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3631
Mailing Address - Country:US
Mailing Address - Phone:131-462-3007
Mailing Address - Fax:
Practice Address - Street 1:10805 SUNSET OFFICE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1017
Practice Address - Country:US
Practice Address - Phone:314-909-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023014337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health