Provider Demographics
NPI:1003883430
Name:BOTNEY, KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BOTNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WOODCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1337
Mailing Address - Country:US
Mailing Address - Phone:314-692-2788
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 4005
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-567-5016
Practice Address - Fax:314-567-1846
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2G88207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100079OtherMERCY HEALTH PLAN
MO106053OtherBLUE SHIELD
MO202313029Medicaid
MO4078452OtherAETNA
MO5045OtherGROUP HEALTH PLAN
MO4033OtherHEALTHCARE USA
MO774260OtherFIRST HEALTH
MO3140746OtherCIGNA
MO0700174OtherUNITED HEALTHCARE
MO117448OtherHEALTHLINK
MOA28606Medicare UPIN
MO008012376Medicare ID - Type Unspecified
MO100079OtherMERCY HEALTH PLAN