Individual provider Active NPI

Katherine Marie Kiely, PNP

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1467961482
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2017032218 Issued in MO
Practice address
1 Childrens PL
Div Ped Gastro, Hepatology and Nutrition
Saint Louis, MO 63110-1002
Phone
(314) 454-6173
Fax
(844) 231-8912
NPI assigned
Sep 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2017032218 MO Primary

Addresses

Primary practice location

1 Childrens PL
Div Ped Gastro, Hepatology and Nutrition
Saint Louis, MO 63110-1002

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-6173

Other identifiers 1

IdentifierTypeStateIssuer
420047372MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171020001597 MO Practitioner - Nurse Practitioner 0042586950 Reassigns benefits to 1 organization
I20180926001569 IL Practitioner - Nurse Practitioner 0042586950 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2017032218MOMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University Physicians in Illinois, Inc Current Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Aug 5, 2018 Accepting new patients
Washington University CurrentSince Sep 18, 2017 Accepting new patients
Washington University CurrentSince Sep 18, 2017 Accepting new patients
Washington University Physicians in Illinois, Inc. CurrentSince Aug 5, 2018 Accepting new patients
Washington University Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

1224 Graham Rd
Ste 2010
Florissant, MO 63031
Phone (314) 839-5232

1 Childrens Pl
#8116
Saint Louis, MO 63110
Phone (314) 454-6095

1 Childrens Pl
#1230
Saint Louis, MO 63110

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

13001 North Outer 40 Rd
Town and Country, MO 63017
Phone (314) 454-3013

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1467961482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-6173",
            "fax_number": "844-231-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "DIV PED GASTRO, HEPATOLOGY AND NUTRITION",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6173",
            "fax_number": "844-231-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIELY",
        "first_name": "KATHERINE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2017032218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420047372",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1 Childrens Pl",
            "address_2": "Div Ped Gastro, Hepatology and Nutrition",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.