Healthcare Provider Details

I. General information

NPI: 1124440102
Provider Name (Legal Business Name): ALISA KINDIG CWHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S LINDBERGH BLVD STE 210
SAINT LOUIS MO
63127-1387
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-1009
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-0420
  • Fax:
Mailing address:
  • Phone: 314-525-0420
  • Fax: 314-996-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF148416
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF148416
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014005732
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2014005732
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: