Healthcare Provider Details

I. General information

NPI: 1063663086
Provider Name (Legal Business Name): KAY SUMMERS R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 DALE CT
BALLWIN MO
63011-3005
US

IV. Provider business mailing address

219 DALE CT
BALLWIN MO
63011-3005
US

V. Phone/Fax

Practice location:
  • Phone: 314-805-1148
  • Fax:
Mailing address:
  • Phone: 314-805-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number2005034649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: