Healthcare Provider Details

I. General information

NPI: 1447998364
Provider Name (Legal Business Name): KATHLEEN C GITTEMEIER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

8 MAPLE DR
SAINT PETERS MO
63376-1426
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6000
  • Fax:
Mailing address:
  • Phone: 314-420-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022017079
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2022017079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: