Healthcare Provider Details

I. General information

NPI: 1598409567
Provider Name (Legal Business Name): MATTIE ELIZABETH KERNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL MSC 8208-0016-06
ST. LOUIS MO
63110
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8208-0016-06
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6050
  • Fax: 855-887-7850
Mailing address:
  • Phone: 314-454-6050
  • Fax: 855-887-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025025161
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: