Provider Demographics
NPI:1043823222
Name:MCCUTCHEN, KAILEY JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:JEAN
Last Name:MCCUTCHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BOWLES AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2387
Mailing Address - Country:US
Mailing Address - Phone:314-617-2970
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVE STE 400
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2387
Practice Address - Country:US
Practice Address - Phone:314-617-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200224629363LF0000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery