Individual
TAYLOR RAE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1225 GRAHAM RD STE C-1340, FLORISSANT, MO 63031-8019
(314) 953-8271
Mailing address
PO BOX 959354, SAINT LOUIS, MO 63195-9354
(314) 953-8271
(314) 953-8272
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2016023237
MO
363L00000X
Nurse Practitioner
Primary
2023037394
MO
363LF0000X
Family Nurse Practitioner
209029415
IL
363LP2300X
Primary Care Nurse Practitioner
2023037394
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16161910
CAQH ID
—
01
—
209029415
NP LICENSE
IL
Enumeration date
01/04/2024
Last updated
09/17/2025
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