Healthcare Provider Details

I. General information

NPI: 1477981454
Provider Name (Legal Business Name): KATHLEEN ELIZABETH EDDINGTON MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD STE 212
SAINT LOUIS MO
63117-1850
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-3432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number139366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: