Healthcare Provider Details

I. General information

NPI: 1972398105
Provider Name (Legal Business Name): COURTNEY P KEDROSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S WOODS MILL RD STE 140
CHESTERFIELD MO
63017-3427
US

IV. Provider business mailing address

400 S WOODS MILL RD STE 140
CHESTERFIELD MO
63017-3427
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-1101
  • Fax:
Mailing address:
  • Phone: 314-485-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019037638
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2025022094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: