MEDICARE: NATALIE MARIE ST CLAIR PMHNP-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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53-81725-042	KS

General Provider Information

NPI Number	:	1326758467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MARIE ST CLAIR PMHNP-BC

Provider Business Mailing Address
First Line	:	1148 S HILLSIDE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

Provider Business Practice Location Address
First Line	:	1148 S HILLSIDE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

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

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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