Healthcare Provider Details

I. General information

NPI: 1861585689
Provider Name (Legal Business Name): KATHERINE D SIEBERT F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 RICHARDSON SQUARE DR. SUITE 170
ARNOLD MO
63010
US

IV. Provider business mailing address

3619 RICHARDSON SQUARE DR. SUITE 170
ARNOLD MO
63010
US

V. Phone/Fax

Practice location:
  • Phone: 636-717-6776
  • Fax: 314-525-4055
Mailing address:
  • Phone: 636-717-6776
  • Fax: 314-525-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number63255
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number063255
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: