Healthcare Provider Details

I. General information

NPI: 1518745561
Provider Name (Legal Business Name): KATE ALLISON DICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 WELSCH INDUSTRIAL CT
SAINT LOUIS MO
63146-4222
US

IV. Provider business mailing address

1304 CHERRY BLOSSOM DR
O FALLON MO
63368-3610
US

V. Phone/Fax

Practice location:
  • Phone: 224-383-8543
  • Fax:
Mailing address:
  • Phone: 636-439-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number2023023198
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: