Provider Demographics
NPI:1548752991
Name:DAMRON, KAITLIN MAREE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:MAREE
Last Name:DAMRON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:KAITLIN
Other - Middle Name:MAREE
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 SIMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2740
Mailing Address - Country:US
Mailing Address - Phone:314-488-7018
Mailing Address - Fax:
Practice Address - Street 1:5203 CHIPPEWA ST STE 301
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2356
Practice Address - Country:US
Practice Address - Phone:314-481-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF04180415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily