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General NPI Number Information
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NPI Number | 1588480842
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Entity Type | Individual
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Provider Name | KILANNIN CATHLEEN KRYSIAK PHD, FACMG
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 4320 FOREST PARK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2979
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Country | US
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Telephone | 314-273-4218
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Fax |
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE # 81189902
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone |
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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 | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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