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General NPI Number Information
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NPI Number | 1780384271
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Entity Type | Individual
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Provider Name | MS. CORTNEY KISSEL
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 9735 LANDMARK PARKWAY DR STE 201
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1666
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Country | US
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Telephone | 314-543-6984
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 314-525-1877
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AG02230087
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License Number State | MO
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