Provider Demographics
NPI:1336629641
Name:SMITH, CATHERINE DOLPHIN (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DOLPHIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON RD STE 120B
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-256-5070
Mailing Address - Fax:696-256-5066
Practice Address - Street 1:15945 CLAYTON RD STE 120B
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5070
Practice Address - Fax:636-256-5066
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018024092363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology