Healthcare Provider Details

I. General information

NPI: 1922912724
Provider Name (Legal Business Name): KATHRYN DEAN AGARWAL MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BALLAS CT
SAINT LOUIS MO
63131-3021
US

IV. Provider business mailing address

100 BALLAS CT
SAINT LOUIS MO
63131-3021
US

V. Phone/Fax

Practice location:
  • Phone: 863-205-7767
  • Fax:
Mailing address:
  • Phone: 863-205-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number2016027172
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: