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General NPI Number Information
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NPI Number | 1346823275
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Entity Type | Individual
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Provider Name | KRISTIN LOUISE STAATS FNP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 100 MEDICAL PLZ
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-625-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 75 SCOTSDALE CT
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City | SAINT PETERS
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State | MO
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Zip | 63376-7664
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Country | US
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Telephone | 573-268-8601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2020030802
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License Number State | MO
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