Provider Demographics
NPI:1174339709
Name:TOLLIVER, KASEY L
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:L
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SAINT NICHOLAS LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6741
Mailing Address - Country:US
Mailing Address - Phone:314-484-5248
Mailing Address - Fax:
Practice Address - Street 1:130 SAINT NICHOLAS LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6741
Practice Address - Country:US
Practice Address - Phone:314-484-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula