Healthcare Provider Details

I. General information

NPI: 1447343645
Provider Name (Legal Business Name): KAREN TRIPPE NICHOLS RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1810
US

IV. Provider business mailing address

812 E HAVEN DR
WATERLOO IL
62298-2933
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-7669
  • Fax: 314-849-7670
Mailing address:
  • Phone: 618-939-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2003003305
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: