Healthcare Provider Details

I. General information

NPI: 1114855590
Provider Name (Legal Business Name): KATRINA STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7827 TOWN SQUARE AVE STE 104
O FALLON MO
63368-7199
US

IV. Provider business mailing address

39 KASSEBAUM LN APT 304
SAINT LOUIS MO
63129-1596
US

V. Phone/Fax

Practice location:
  • Phone: 314-803-0297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2010019398
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: