Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015042830 | MO |
NPI | 1003272964 |
---|---|
Provider Name | Mrs. Kasandra May |
First Address | Saint Louis, MO 63129-3502 |
Second Address | Saint Charles, MO 63303-2759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 01/07/2019 |