MEDICARE: KATHLEEN MILES NIKODYM PA

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	363AS0400X	Surgical Physician Assistant	2002004796	MO
2	363A00000X	Physician Assistant	2002004796	MO

General Provider Information

NPI Number	:	1235210162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MILES NIKODYM PA

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 1ST CAPITOL DR STE 100
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2881
Country	:	US
Telephone Number	:	636-332-8455
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/23/2025

Similar Medicare Providers

1871446104 — MATTHEW WHITE
Practice Location Address:

400 1ST CAPITOL DR STE 100
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-332-8455
Practice Fax:

1477556405 — DR. CHARLES M LINSENMEYER M.D.
Practice Location Address:

400 1ST CAPITOL DR , STE 100
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-946-7050
Practice Fax: 636-946-3368

1649273723 — ST CHARLES ORTHOPAEDIC SURGERY ASSOCIATES INC.
Practice Location Address:

400 1ST CAPITOL DR , STE 100
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-946-7050
Practice Fax: 636-946-3368

1891728051 — MR. JODY T JACHNA MD
Practice Location Address:

400 1ST CAPITOL DR STE 100
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-332-8455
Practice Fax:

1265627210 — MOHSIN EHSAN M.D
Practice Location Address:

400 1ST CAPITOL DR STE 100
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-669-0300
Practice Fax:

1699051284 — MRS. ERIN K DELANEY-SHOFFMAN P.T.
Practice Location Address:

400 1ST CAPITOL DR STE 101
SAINT CHARLES, MO
63301-2881

Practice Phone: 636-947-5467
Practice Fax: 636-947-7084

Directions to “ KATHLEEN MILES NIKODYM PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.