Healthcare Provider Details

I. General information

NPI: 1568724284
Provider Name (Legal Business Name): KATHERINE E CLANCY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE E SEHNERT FNP

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 HIGHWAY K
O FALLON MO
63368-6624
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8512
US

V. Phone/Fax

Practice location:
  • Phone: 636-980-5300
  • Fax: 636-980-5344
Mailing address:
  • Phone: 314-448-3791
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012009885
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012009885
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: