Healthcare Provider Details

I. General information

NPI: 1164132700
Provider Name (Legal Business Name): MOLLY KATHLEEN ORR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK AVE
SAINT LOUIS MO
63110-2514
US

IV. Provider business mailing address

5649 MURDOCH AVE
SAINT LOUIS MO
63109-2868
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5609
  • Fax:
Mailing address:
  • Phone: 314-221-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022007242
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: