Provider Demographics
NPI:1134147648
Name:LOBELLO, KATHLEEN P (ANP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:P
Last Name:LOBELLO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8242
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:314-576-8880
Practice Address - Street 1:1040 N MASON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6399
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:314-576-8880
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO065304363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425707312Medicaid
IL$$$$$$$$$001Medicaid
000081201Medicare PIN
P40149Medicare UPIN
823640219Medicare PIN
MO425707312Medicaid