Healthcare Provider Details

I. General information

NPI: 1346150497
Provider Name (Legal Business Name): KENDALL MARIE MACDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8052 DAVIS DR APT 2E
SAINT LOUIS MO
63105-2558
US

IV. Provider business mailing address

8052 DAVIS DR APT 2E
SAINT LOUIS MO
63105-2558
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-9195
  • Fax:
Mailing address:
  • Phone: 314-518-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026040939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: