Provider Demographics
NPI:1326117581
Name:BURCH, MARY KATHERINE (RNC, WHNP, MC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:BURCH
Suffix:
Gender:F
Credentials:RNC, WHNP, MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11652 STUDT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7025
Mailing Address - Country:US
Mailing Address - Phone:314-991-5445
Mailing Address - Fax:314-991-5447
Practice Address - Street 1:11652 STUDT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7025
Practice Address - Country:US
Practice Address - Phone:314-991-5445
Practice Address - Fax:314-991-5447
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999138040363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO121918OtherADVANTRA
MO121918OtherGROUP HEALTH PLAN
MO412030177OtherCIGNA
MOF82867OtherMERCY
MO002013479OtherMEDICARE ID-TYPE UNSPECIFIED
MO121918OtherCMR
MO027213OtherFMH EXCLUSIVE CHOICE
MO160057764OtherRR MEDICARE
MO33180OtherBLUE CHOICE
MO412030177OtherGOLDEN RULE
MO288803OtherHEALTHLINK
MO33810OtherBLUE CROSS BLUE SHIELD
MO412030177OtherGREAT WEST
MO412030177OtherUNITED HEALTHCARE
MO7407000OtherMEDICARE COMPLETE
MO027213OtherFMH EXCLUSIVE CHOICE