Healthcare Provider Details

I. General information

NPI: 1629031851
Provider Name (Legal Business Name): LINDA KAISER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WATERBURY FALLS DR
O FALLON MO
63368-2215
US

IV. Provider business mailing address

316 ADDYSTON POINTE
SAINT PETERS MO
63376-2450
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-289-6360
Mailing address:
  • Phone: 314-422-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number083502
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: