Healthcare Provider Details

I. General information

NPI: 1255261525
Provider Name (Legal Business Name): KATE D MASSMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 07/28/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED ENDOCRINOLOGY AND DIABETES
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6051
  • Fax: 314-454-6225
Mailing address:
  • Phone: 314-454-6051
  • Fax: 314-454-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2021009243
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: