Individual provider Active NPI

Ebitari O Fregene, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Urbandale, IA
National Provider Identifier
1003646795
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2024031047 Issued in MO
Practice address
8517 Airline Ave
Urbandale, IA 50322-2317
Phone
(636) 634-5668
NPI assigned
Aug 6, 2024
Last updated
Jul 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2024031047 MO Primary

Addresses

Primary practice location

8517 Airline Ave
Urbandale, IA 50322-2317

Mailing address

115 Golden Gate Pkwy
Wentzville, MO 63385-7288
Phone (636) 634-5668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241007003380 MO Practitioner - Nurse Practitioner 4587195177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

115 Golden Gate Pkwy
Wentzville, MO 63385-7288

8517 Airline Ave
Urbandale, IA 50322-2317

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024031047MOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Serenity Health LLC CurrentSince Aug 1, 2024 Accepting new patients
Beth Psychiatry LLC PastSince Sep 3, 2025 Accepting new patients
Beth Psychiatry LLC Psychiatric/Mental Health PastSince Dec 12, 2023 Accepting new patients
St. Louis Internal Medicine Inc PastSince Aug 1, 2024 Accepting new patients

Locations

5000 Cedar Plaza Pkwy
Ste 350
Saint Louis, MO 63128
Phone (314) 843-4333

4905 Mexico Rd
Ste 400
Saint Peters, MO 63376
Phone (314) 862-4840

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1003646795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 GOLDEN GATE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633857288",
            "telephone_number": "636-634-5668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8517 AIRLINE AVE",
            "city": "URBANDALE",
            "state": "IA",
            "postal_code": "503222317",
            "telephone_number": "636-634-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREGENE",
        "first_name": "EBITARI",
        "middle_name": "O",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2024031047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbandale, IA

Sources for this page

Verify at the official NPI Registry.