Healthcare Provider Details

I. General information

NPI: 1548752991
Provider Name (Legal Business Name): KAITLIN MAREE DAMRON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KAITLIN MAREE WERNER

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 CHIPPEWA ST STE 301
SAINT LOUIS MO
63109-2356
US

IV. Provider business mailing address

634 SIMMONS AVE
KIRKWOOD MO
63122-2740
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-5000
  • Fax:
Mailing address:
  • Phone: 314-488-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04180415
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: