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General NPI Number Information
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NPI Number | 1568180289
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Entity Type | Individual
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Provider Name | KAY MICHELLE WUNDERLICH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 13655 RIVERPORT DR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-4812
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Country | US
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Telephone | 314-254-1865
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 SHENANDOAH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1756
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Country | US
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Telephone | 314-600-8461
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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 | 2022032857
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License Number State | MO
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