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NPI Code Detail

MEDICARE: TERRI L KOLKER PA-C

MEDICARE: TERRI L KOLKER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant105167MO
2363A00000XPhysician Assistant105167MO

General Provider Information

NPI Number : 1043285638
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRI L KOLKER PA-C
Provider Business Mailing Address
First Line : 3023 N BALLAS RD STE 200D
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2328
Country : US
Telephone Number : 314-996-7272
Fax Number :
Provider Business Practice Location Address
First Line : 3023 N BALLAS RD STE 200D
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2328
Country : US
Telephone Number : 314-996-7272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 11/26/2021

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Directions to “ TERRI L KOLKER PA-C” Practice Location

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