Basic Information
| Provider Information | |||||||||
| NPI: | 1497923874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRILLMAN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 339 CONSORT DR | ||||||||
| Address2: | |||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630114439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363869224 | ||||||||
| FaxNumber: | 6363867679 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630903127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362398301 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2008 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2002015463 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1497923874 | 05 | MO | MEDICAID | P00651225 | 01 | MO | RAILROAD MEDICARE | OTHER |