MEDICARE: TABITHA KENNEDY-SLEEPER APRN,MSN, PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025050092	MO

General Provider Information

NPI Number	:	1285596957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA KENNEDY-SLEEPER APRN,MSN, PMHNP

Provider Business Mailing Address
First Line	:	540 LEGACY POINTE DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2263
Country	:	US
Telephone Number	:	314-484-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 LEGACY POINTE DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2263
Country	:	US
Telephone Number	:	314-484-4433
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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