MEDICARE: MS. KATHLEEN EVA DAWSON

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	363L00000X	Nurse Practitioner	2010014385	MO

General Provider Information

NPI Number	:	1992009419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN EVA DAWSON

Provider Business Mailing Address
First Line	:	8112 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3736
Country	:	US
Telephone Number	:	314-725-5556
Fax Number	:	314-725-2223

Provider Business Practice Location Address
First Line	:	8112 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3736
Country	:	US
Telephone Number	:	314-725-5556
Fax Number	:	314-725-2223

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

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	04/16/2011

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