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General NPI Number Information
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NPI Number | 1548752991
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Entity Type | Individual
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Provider Name | KAITLIN MAREE DAMRON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 5203 CHIPPEWA ST STE 301
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2356
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Country | US
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Telephone | 314-481-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 634 SIMMONS AVE
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City | KIRKWOOD
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State | MO
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Zip | 63122-2740
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Country | US
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Telephone | 314-488-7018
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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 | F04180415
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License Number State | MO
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