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General NPI Number Information
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NPI Number | 1184560575
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Entity Type | Organization
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Legal Business Name | KATIE DIENELL PAC LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 4401 MERAMEC BOTTOM RD STE C
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City | SAINT LOUIS
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State | MO
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Zip | 63129-2564
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Country | US
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Telephone | 314-583-9551
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Fax | 636-791-0306
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Provider Business Mailing Address
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Address Line | 4401 MERAMEC BOTTOM RD STE C
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City | SAINT LOUIS
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State | MO
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Zip | 63129-2564
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Country | US
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Telephone |
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Fax | 636-791-0306
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Authorized Official
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Title or Position | OWNER PHYSICIAN ASSISTANT
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Name | KATIE TUHILL
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Credential | PA-C
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Telephone | 314-583-9551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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