Healthcare Provider Details

I. General information

NPI: 1003514563
Provider Name (Legal Business Name): CATHERINE NAILAEN MEPUKORI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
ST. CHARLES MO
63304-9101
US

IV. Provider business mailing address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

V. Phone/Fax

Practice location:
  • Phone: 314-556-7612
  • Fax:
Mailing address:
  • Phone: 314-556-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023008021
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: