Healthcare Provider Details

I. General information

NPI: 1346043767
Provider Name (Legal Business Name): KATELYN MARILYN AMANN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE STE 341
SAINT LOUIS MO
63108-1453
US

IV. Provider business mailing address

206 ROGERS ST
WATERLOO IL
62298-1597
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-7882
  • Fax:
Mailing address:
  • Phone: 217-549-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2025011516
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: