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NPI Code Detail

MEDICARE: KAITLIN RHODES THORSON AGPCNP-BC

MEDICARE:   KAITLIN RHODES THORSON  AGPCNP-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
1163WC0200XCritical Care Medicine Registered Nurse2015003836MO
2363LA2200XAdult Health Nurse Practitioner2021017273MO

General Provider Information

NPI Number : 1114591336
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLIN RHODES THORSON AGPCNP-BC
Provider Business Mailing Address
First Line : 232 S WOODS MILL RD # 6500
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-3485
Country : US
Telephone Number : 314-205-6965
Fax Number :
Provider Business Practice Location Address
First Line : 232 S WOODS MILL RD # 6500
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-3485
Country : US
Telephone Number : 314-205-6965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2021
Last Update Date : 05/15/2021

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Directions to “ KAITLIN RHODES THORSON AGPCNP-BC” Practice Location

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