Provider Demographics
NPI:1083127344
Name:SEYMOUR, MARY KRISTIN (MSN, RN, APRN-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTIN
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MSN, RN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 DELMAR BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2168
Mailing Address - Country:US
Mailing Address - Phone:314-307-7305
Mailing Address - Fax:
Practice Address - Street 1:8515 DELMAR BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2168
Practice Address - Country:US
Practice Address - Phone:314-307-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155981364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty