Healthcare Provider Details

I. General information

NPI: 1184594244
Provider Name (Legal Business Name): KAITLYN NICOLE SEKULSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 VETERANS MEMORIAL PKWY
SAINT CHARLES MO
63303-2106
US

IV. Provider business mailing address

711 ASTER LN
O FALLON MO
63366-1807
US

V. Phone/Fax

Practice location:
  • Phone: 636-669-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2025047351
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: