Healthcare Provider Details

I. General information

NPI: 1811997505
Provider Name (Legal Business Name): KRISTEN L. ROWE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ SUITE 310
LAKE ST LOUIS MO
63367-1481
US

IV. Provider business mailing address

1413 WENTZVILLE PKWY
WENTZVILLE MO
63385-3407
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-2662
  • Fax: 636-625-6623
Mailing address:
  • Phone: 636-332-5400
  • Fax: 636-332-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23869
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007033674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: