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General NPI Number Information
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NPI Number | 1922714575
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Entity Type | Individual
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Provider Name | STELLA KULKIN HEINE AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1225 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-977-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 S SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-977-5060
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Fax | 314-977-1664
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2022046449
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License Number State | MO
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