Provider Demographics
NPI:1174128649
Name:MARSHALL, KATHERINE LEE (NP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LEE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEE
Other - Last Name:MASUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1124 FOREST SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6310
Mailing Address - Country:US
Mailing Address - Phone:636-484-0341
Mailing Address - Fax:
Practice Address - Street 1:2070 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2308
Practice Address - Country:US
Practice Address - Phone:314-434-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028099363L00000X
MO2020028088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner