Provider Demographics
NPI:1619065331
Name:CARDINAL, KARA (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S NEW BALLAS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8702
Mailing Address - Country:US
Mailing Address - Phone:314-251-8850
Mailing Address - Fax:314-569-3846
Practice Address - Street 1:701 S NEW BALLAS RD STE 330
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8702
Practice Address - Country:US
Practice Address - Phone:314-251-8850
Practice Address - Fax:314-569-3846
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006031529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01362130OtherRAILROAD MEDICARE
MO1074081OtherNCCPA CERTIFICATION
MOP01362130OtherRAILROAD MEDICARE