Mary Deane Kitchura, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2025040004 Issued in MO

Practice address

15945 Clayton Rd Ste 120a
Ballwin, MO 63011-2490

Phone

(636) 256-5000

Fax

(636) 256-5100

NPI assigned

Jun 18, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mercy Clinic St. Louis Cancer and Breast Institute, LLC

  • Surgical Oncology Physician
  • Saint Louis, MO
  • NPI 1891946349
  Medicare reassignment NPD
• Mercy Hospitals East Communities

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1427098169
  NPD (past)

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1538056148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "573-237-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 120A",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112490",
            "telephone_number": "636-256-5000",
            "fax_number": "636-256-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9513 Highway 100",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "MO",
            "postal_code": "630681300",
            "country_code": "US",
            "telephone_number": "573-237-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITCHURA",
        "first_name": "MARY",
        "middle_name": "DEANE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-18",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2025040004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James W Ketchum, MD
• Kevin F. Postol D.D.S. LLC
• Kimberly D Simonds DDS PC
• Melissa Jean Kinney, MS, BCBA, LBA
• Shireen Kinzy, M.S. CCC-SLP
• Diane Elizabeth Klenke, MA. PLPC
• Mary Kathleen Klepzig, FNP
• Catherine Ann Kluge, LPC
• Rita Voigt Knesel, OTR/L
• Ryan Knuckles

• Physician Assistant in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.