Provider Demographics
NPI:1851190326
Name:GIESING, KORISSA MICHELLE
Entity type:Individual
Prefix:
First Name:KORISSA
Middle Name:MICHELLE
Last Name:GIESING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 WOODBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TRUESDALE
Mailing Address - State:MO
Mailing Address - Zip Code:63380-1211
Mailing Address - Country:US
Mailing Address - Phone:319-201-8334
Mailing Address - Fax:
Practice Address - Street 1:9556 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1313
Practice Address - Country:US
Practice Address - Phone:319-201-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical