Katherine Marie Lally, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

12639 Old Tesson Rd Ste 115
Saint Louis, MO 63128-2786

Phone

(314) 849-0311

Fax

(314) 849-4423

NPI assigned

Mar 22, 2006

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

Other names 1

• Ms. Katherine Marie Pudlowski Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katherine.lally@direct.signature.nextgenshare.com
• Direct secure messaging: katherine.lally@direcct.signature.nextgenshare.com

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.

• Signature Medical Group, Inc

  • Orthopaedic Surgery Physician
  • Saint Louis, MO
  • NPI 1871542761
  Medicare reassignment NPD
• Signature Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Chesterfield, MO
  • NPI 1982473153
  NPD
• Richard M Vazquez MD SC

  • Surgery Physician
  • Chicago, IL
  • NPI 1770752883
  NPD (past)

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1649239187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT FL 2",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417134",
            "telephone_number": "314-983-4700",
            "fax_number": "314-567-7520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12639 OLD TESSON RD STE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282786",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLY",
        "first_name": "KATHERINE",
        "middle_name": "MARIE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Katherine.lally@direcct.signature.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "845 N New Ballas Ct Fl 2",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631417134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "PUDLOWSKI",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lakshmi V. Dundoo, MD, PC
• Anand Lakshminarasimhachar, MD
• Lal Home Health Agency
• Victoria Lynn Lal, AGNP
• Juliana Lally, LCSW
• Madison Lally
• Ernesto S. Lam, M.D.
• Jacob Lam, MD
• Jason Khoa Lam, DO
• Shalu Lama, AGACNP

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, 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 19, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.