Healthcare Provider Details

I. General information

NPI: 1124941844
Provider Name (Legal Business Name): KARA NOLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10174 W FLORISSANT AVE
SAINT LOUIS MO
63136-2104
US

IV. Provider business mailing address

4206 OAKWOOD AVE
SAINT LOUIS MO
63121-3355
US

V. Phone/Fax

Practice location:
  • Phone: 314-425-9668
  • Fax:
Mailing address:
  • Phone: 314-425-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: