Provider Demographics
NPI:1861585689
Name:SIEBERT, KATHERINE D (FNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 RICHARDSON SQUARE DR.
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010
Mailing Address - Country:US
Mailing Address - Phone:636-717-6776
Mailing Address - Fax:314-525-4055
Practice Address - Street 1:3619 RICHARDSON SQUARE DR.
Practice Address - Street 2:SUITE 170
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-717-6776
Practice Address - Fax:314-525-4055
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO63255163W00000X
MO063255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428989305Medicaid
MO000082167Medicare ID - Type Unspecified
MO428989305Medicaid