Provider Demographics
NPI:1720137383
Name:AUDETTE, KATHERINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:AUDETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2127 SEVEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2215
Mailing Address - Country:US
Mailing Address - Phone:314-609-9248
Mailing Address - Fax:314-289-6543
Practice Address - Street 1:515 NORTH JEFFERSON
Practice Address - Street 2:VA HOPE RECOVERY CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103
Practice Address - Country:US
Practice Address - Phone:314-609-9248
Practice Address - Fax:314-289-6543
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109101Y00000X
MO1307101YA0400X
IL041248420163W00000X
MO081329163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse