Basic Information
| Provider Information | |||||||||
| NPI: | 1619130010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHILDRESS | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | MARIE SCOLARI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 CLAYTON RD DEPT OF | ||||||||
| Address2: | SUITE 291, 2ND FLOOR | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688873 | ||||||||
| FaxNumber: | 3146458771 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 CLAYTON RD DEPT OF | ||||||||
| Address2: | SUITE 291, 2ND FLOOR | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147814772 | ||||||||
| FaxNumber: | 3146458771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2008015415 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 2012014548 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.