Provider Demographics
NPI:1316943764
Name:BERNS, KATHRYN A (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:BERNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:636-937-7812
Mailing Address - Fax:636-937-7821
Practice Address - Street 1:1447 US HIGHWAY 61
Practice Address - Street 2:STE B
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4149
Practice Address - Country:US
Practice Address - Phone:636-937-7812
Practice Address - Fax:636-937-7821
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003171363L00000X
MO126604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00099351OtherMEDICARE RAILROAD
IL533754OtherHEALTHLINK
ILL98427Medicare ID - Type Unspecified
P77324Medicare UPIN