Provider Demographics
NPI:1275161002
Name:REANO, KATHERINE DOMINIQUE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DOMINIQUE
Last Name:REANO
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 1:6524 HOFF RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72940-9580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 S NEW BALLAS RD STE 7020
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8218
Practice Address - Country:US
Practice Address - Phone:314-251-6486
Practice Address - Fax:314-251-4155
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023005754207RC0200X
MO2023027290207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine