Healthcare Provider Details

I. General information

NPI: 1851866495
Provider Name (Legal Business Name): KATHERINE LIEBMAN AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

3061 CAMBRIDGE POINTE DR
SAINT LOUIS MO
63129-6613
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4275
  • Fax:
Mailing address:
  • Phone: 314-309-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2018020911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: