Healthcare Provider Details

I. General information

NPI: 1043528540
Provider Name (Legal Business Name): RACHEL YOON KMETZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 499A
SAINT LOUIS MO
63141-8260
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 499A
SAINT LOUIS MO
63141-8260
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7650
  • Fax:
Mailing address:
  • Phone: 314-251-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberY50072087950
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036149980
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2015020400
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2021018181
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: