Healthcare Provider Details

I. General information

NPI: 1073123915
Provider Name (Legal Business Name): KENDRA OWEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 200D
SAINT LOUIS MO
63131-2328
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8512
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7272
  • Fax:
Mailing address:
  • Phone: 314-448-3791
  • Fax: 319-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2023043566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: