Healthcare Provider Details

I. General information

NPI: 1487058624
Provider Name (Legal Business Name): KATHY ANNE MEJIA PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY ANNE ROGERS

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9666 OLIVE BLVD SUITE 400
SAINT LOUIS MO
63132-3013
US

IV. Provider business mailing address

9666 OLIVE BLVD SUITE 400
SAINT LOUIS MO
63132-3013
US

V. Phone/Fax

Practice location:
  • Phone: 636-448-7642
  • Fax:
Mailing address:
  • Phone: 636-448-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2013033730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: