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General NPI Number Information
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NPI Number | 1649239187
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Entity Type | Individual
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Provider Name | KATHERINE MARIE LALLY PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 12639 OLD TESSON RD STE 115
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2786
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Country | US
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Telephone | 314-849-0311
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Fax | 314-849-4423
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Provider Business Mailing Address
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Address Line | 845 N NEW BALLAS CT FL 2
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7134
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Country | US
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Telephone | 314-983-4700
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Fax | 314-567-7520
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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