Healthcare Provider Details

I. General information

NPI: 1114591336
Provider Name (Legal Business Name): KAITLIN RHODES THORSON AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLIN MARIE RHODES RN

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/15/2021
Certification Date: 05/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD # 6500
CHESTERFIELD MO
63017-3485
US

IV. Provider business mailing address

232 S WOODS MILL RD # 6500
CHESTERFIELD MO
63017-3485
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6965
  • Fax:
Mailing address:
  • Phone: 314-205-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2015003836
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2021017273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: