Healthcare Provider Details

I. General information

NPI: 1699685750
Provider Name (Legal Business Name): KATIE MARIE MEYERKORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 TARA CT
CHESTERFIELD MO
63005-3612
US

IV. Provider business mailing address

957 TARA CT
CHESTERFIELD MO
63005-3612
US

V. Phone/Fax

Practice location:
  • Phone: 314-258-3376
  • Fax:
Mailing address:
  • Phone: 314-258-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2026025207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: