Healthcare Provider Details

I. General information

NPI: 1174183289
Provider Name (Legal Business Name): KATELYN MORING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

203 CHADWYCK CIR
HERCULANEUM MO
63048-1751
US

V. Phone/Fax

Practice location:
  • Phone: 314-486-5388
  • Fax:
Mailing address:
  • Phone: 314-775-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2019010870
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: