Provider Demographics
NPI:1861959769
Name:VENEGONI, KATHERINE ELLEN (NP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN
Last Name:VENEGONI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 YORK DR APT 102
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2934
Mailing Address - Country:US
Mailing Address - Phone:636-358-2752
Mailing Address - Fax:
Practice Address - Street 1:105 CREEKSIDE OFFICE DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3289
Practice Address - Country:US
Practice Address - Phone:636-639-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner