Healthcare Provider Details

I. General information

NPI: 1326543968
Provider Name (Legal Business Name): KATHERINE LYNN MISTRETTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DEPT ORTHOPAEDIC SURGERY, STE 6A/6B/12A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2551
  • Fax: 314-747-2598
Mailing address:
  • Phone: 314-747-2551
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32152
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2023021803
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: