Healthcare Provider Details

I. General information

NPI: 1144584822
Provider Name (Legal Business Name): KATHLEEN ELANE KNAPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD FDT, 14TH FLOOR
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

1850 N CENTRAL AVE STE 1600
PHOENIX AZ
85004-4633
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-9852
  • Fax:
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2012018759
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47692
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: