Provider Demographics
NPI:1841611746
Name:MCGOUGAN, DAVA M (CNP)
Entity type:Individual
Prefix:MS
First Name:DAVA
Middle Name:M
Last Name:MCGOUGAN
Suffix:
Gender:F
Credentials:CNP
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 1:4800 N SCOTTSDALE RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2458 OLD DORSETT RD STE 110
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2423
Practice Address - Country:US
Practice Address - Phone:314-476-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013037722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health