Provider Demographics
NPI:1063578946
Name:FKA, INC.
Entity type:Organization
Organization Name:FKA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-441-7608
Mailing Address - Street 1:5301 VETERANS MEMORIAL PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-2126
Mailing Address - Fax:636-441-2028
Practice Address - Street 1:5301 VETERANS MEMORIAL PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-441-2126
Practice Address - Fax:636-441-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9C94207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty