Individual provider Active NPI

Katherine L Mulherin, N.P.

  • Family Nurse Practitioner
  • Fenton, MO
National Provider Identifier
1780902882
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
105483 Issued in MO
Practice address
128 Matrix Commons Dr
Fenton, MO 63026
Phone
(636) 349-6850
Fax
(636) 349-6641
NPI assigned
May 13, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 105483 MO Primary

Addresses

Primary practice location

128 Matrix Commons Dr
Fenton, MO 63026

Mailing address

128 Matrix Commons Dr
Fenton, MO 63026-2935
Phone (314) 731-9675

Other identifiers 1

IdentifierTypeStateIssuer
MA5364047MedicaidMO

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160121000333 MO Practitioner - Nurse Practitioner 1052614302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care of Kansas PAGroup PAC ID 5991029159, 25 clinicians

Practice addresses (Care Compare)

463 Lynn Haven LN
Hazelwood, MO 63042-1808
Phone (314) 731-0448

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
105483MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care of Kansas PA CurrentSince Jan 4, 2016 Accepting new patients
American Current Care of Kansas PA CurrentSince Jan 4, 2016 Accepting new patients
American Current Care of Kansas PA Current Accepting new patients

Locations

128 Matrix Commons Dr
Fenton, MO 63026
Phone (636) 349-6850

463 Lynn Haven Ln
Hazelwood, MO 63042
Phone (314) 731-0448

6401 E Front St
Kansas City, MO 64120
Phone (816) 241-0603

83 Progress Pkwy
Maryland Hts, MO 63043
Phone (314) 434-8174

5506 Corporate Dr
Ste 1700
Saint Joseph, MO 64507
Phone (816) 671-4880

Organizations & group practices 3

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": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1780902882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MATRIX COMMONS DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262935",
            "telephone_number": "314-731-9675",
            "fax_number": "636-349-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MATRIX COMMONS DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "63026",
            "telephone_number": "636-349-6850",
            "fax_number": "636-349-6641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULHERIN",
        "first_name": "KATHERINE",
        "middle_name": "L",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-13",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "105483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MA5364047",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.