Healthcare Provider Details

I. General information

NPI: 1174235105
Provider Name (Legal Business Name): KAYLA DENISE WEISS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HIGHLANDS PLAZA DR E STE 220
SAINT LOUIS MO
63110-1351
US

IV. Provider business mailing address

1110 HIGHLANDS PLAZA DR E STE 220
SAINT LOUIS MO
63110-1351
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-0195
  • Fax:
Mailing address:
  • Phone: 314-273-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022046127
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2022046127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: