Basic Information
| Provider Information | |||||||||
| NPI: | 1780902882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULHERIN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 MATRIX COMMONS DR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630262935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147319675 | ||||||||
| FaxNumber: | 6363496850 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 MATRIX COMMONS DR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363496850 | ||||||||
| FaxNumber: | 6363496641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 105483 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MA5364047 | 05 | MO | MEDICAID |