Provider Demographics
NPI:1114591336
Name:THORSON, KAITLIN RHODES (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:RHODES
Last Name:THORSON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARIE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:232 S WOODS MILL RD # 6500
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3485
Mailing Address - Country:US
Mailing Address - Phone:314-205-6965
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD # 6500
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3485
Practice Address - Country:US
Practice Address - Phone:314-205-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015003836163WC0200X
MO2021017273363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine