Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Daniel Zackary Souvannarath

Individual provider Physician Assistant · NPI 1174144828

Daniel Zackary Souvannarath is a Physician Assistant in Bridgeton, Missouri. Works from 2 locations. Licensed in Missouri.

Licensed in
MO
In the registry since
2020
Specialties on file
2

Practice location Address checks out

12266 De Paul Dr Ste 310
Bridgeton, MO 63044-2562
Phone: (314) 209-5171
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3437 Caroline St Ste 3082, Saint Louis, MO 63104-1111 — (314) 977-8648

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2021010216 (MO)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1174144828
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 5, 2020
Last updated in NPPESSeptember 13, 2021
Certification dateSeptember 13, 2021

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