Provider Demographics
NPI:1538056148
Name:KITCHURA, MARY DEANE (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DEANE
Last Name:KITCHURA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:920 ROCKY COVE DR
Mailing Address - Street 2:
Mailing Address - City:LABADIE
Mailing Address - State:MO
Mailing Address - Zip Code:63055-1988
Mailing Address - Country:US
Mailing Address - Phone:314-365-4767
Mailing Address - Fax:
Practice Address - Street 1:15945 CLAYTON RD STE 120A
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5000
Practice Address - Fax:636-256-5100
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant