Healthcare Provider Details

I. General information

NPI: 1760364434
Provider Name (Legal Business Name): KAITLYN MARIE SOLOMON AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 GRAVOIS RD STE 210
FENTON MO
63026-7723
US

IV. Provider business mailing address

PO BOX 419052
SAINT LOUIS MO
63141-9052
US

V. Phone/Fax

Practice location:
  • Phone: 636-660-9850
  • Fax: 636-660-9851
Mailing address:
  • Phone: 314-851-1000
  • Fax: 314-851-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2023014975
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: