Healthcare Provider Details

I. General information

NPI: 1568180289
Provider Name (Legal Business Name): KAY MICHELLE WUNDERLICH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY SEEMILLER

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6994 MEXICO RD
SAINT PETERS MO
63376-1512
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-3231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022032857
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: