Provider Demographics
NPI:1255965422
Name:RICHTER, KAYLA MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MAPLEWOOD COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1003
Mailing Address - Country:US
Mailing Address - Phone:314-293-4023
Mailing Address - Fax:
Practice Address - Street 1:2015 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-1003
Practice Address - Country:US
Practice Address - Phone:314-293-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MO2020007938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant