Provider Demographics
NPI:1124440102
Name:KINDIG, ALISA (CWHNP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:KINDIG
Suffix:
Gender:F
Credentials:CWHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-1009
Mailing Address - Country:US
Mailing Address - Phone:314-525-0420
Mailing Address - Fax:314-996-7561
Practice Address - Street 1:1475 KISKER RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8788
Practice Address - Country:US
Practice Address - Phone:636-498-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF148416363L00000X, 363LW0102X
MO2014005732363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPENDINGMedicaid
MO2014005732OtherLICENSE
MO1124440102Medicaid
MOPENDINGOtherRR MCR