Provider Demographics
NPI:1326174079
Name:ST JOHN'S MERCY MEDICAL GROUP
Entity Type:Organization
Organization Name:ST JOHN'S MERCY MEDICAL GROUP
Other - Org Name:ABERCROMBIE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, GNP
Authorized Official - Phone:636-282-9899
Mailing Address - Street 1:18 FOX VALLEY CTR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2281
Mailing Address - Country:US
Mailing Address - Phone:636-282-9899
Mailing Address - Fax:636-282-2279
Practice Address - Street 1:18 FOX VALLEY CTR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2281
Practice Address - Country:US
Practice Address - Phone:636-282-9899
Practice Address - Fax:636-282-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN127212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty