Provider Demographics
NPI:1972780229
Name:KANNE, ANTOINETTE FRANCES (APRN B-C)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:FRANCES
Last Name:KANNE
Suffix:
Gender:F
Credentials:APRN B-C
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:KANNE
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 560 A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-5744
Mailing Address - Fax:314-251-5745
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 560 A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-5744
Practice Address - Fax:314-251-5745
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO069593364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS79433Medicare UPIN