Healthcare Provider Details

I. General information

NPI: 1972312387
Provider Name (Legal Business Name): KAYLA EVERDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3009 N BALLAS RD STE 102B
SAINT LOUIS MO
63131-2343
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7080
  • Fax:
Mailing address:
  • Phone: 314-996-7080
  • Fax: 314-996-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025018942
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: