Provider Demographics
NPI:1669546396
Name:DORSEY, MARY KATHERINE (APN-BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:APN-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-4325
Mailing Address - Fax:314-525-4365
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-4325
Practice Address - Fax:314-525-4365
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO094700364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423874908Medicaid
MO423874908Medicaid
MOS76669Medicare UPIN