MEDICARE: KAREN M GREGORY APRN BC

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
1	364SM0705X	Medical-Surgical Clinical Nurse Specialist	RN121169	MO

General Provider Information

NPI Number	:	1053389759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M GREGORY APRN BC

Provider Business Mailing Address
First Line	:	1008 S SPRING AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2520
Country	:	US
Telephone Number	:	314-977-4730
Fax Number	:	314-977-1642

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-779-4730
Fax Number	:	314-977-4612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/23/2021

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