Provider Demographics
NPI:1992009419
Name:DAWSON, KATHLEEN EVA
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:EVA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:EVA
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:8112 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3736
Mailing Address - Country:US
Mailing Address - Phone:314-725-5556
Mailing Address - Fax:314-725-2223
Practice Address - Street 1:8112 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3736
Practice Address - Country:US
Practice Address - Phone:314-725-5556
Practice Address - Fax:314-725-2223
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010014385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner