Healthcare Provider Details

I. General information

NPI: 1003445404
Provider Name (Legal Business Name): KAITLYN STURMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 406
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 406
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1224
  • Fax: 314-525-4957
Mailing address:
  • Phone: 314-525-1224
  • Fax: 314-525-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020037054
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: