Healthcare Provider Details

I. General information

NPI: 1922488865
Provider Name (Legal Business Name): KAYE ELIZABETH BRATHWAITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED NEPHROLOGY
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: 314-454-6043
  • Fax: 888-463-6898
Mailing address:
  • Phone: 314-454-6043
  • Fax: 888-463-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022032988
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number2022032988
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: