Provider Demographics
NPI:1598238917
Name:CELLA, KATHARINE LOUISE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:LOUISE
Last Name:CELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-8103
Mailing Address - Fax:314-996-3230
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV IM GENERAL MED, STE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-996-8103
Practice Address - Fax:314-996-3230
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019000563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420070260Medicaid