Healthcare Provider Details

I. General information

NPI: 1952668386
Provider Name (Legal Business Name): KATHERINE HUFFER CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

18336 WOODLAND MEADOWS DR
WILDWOOD MO
63038-1812
US

V. Phone/Fax

Practice location:
  • Phone: 765-412-6638
  • Fax:
Mailing address:
  • Phone: 765-412-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2012008394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: