Healthcare Provider Details

I. General information

NPI: 1841781473
Provider Name (Legal Business Name): KATHLEEN ELIZABETH KOENEN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ELIZABETH HAGENHOFF

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 2007B
SAINT LOUIS MO
63141-8265
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 2007B
SAINT LOUIS MO
63141-8265
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-5000
  • Fax:
Mailing address:
  • Phone: 314-991-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2018030053
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number2011023122
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2018030053
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: