Individual
MRS. HEATHER CHRISTINE LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
615 S NEW BALLAS RD STE 120, SAINT LOUIS, MO 63141-8221
(314) 251-6986
(314) 251-5712
Mailing address
615 S NEW BALLAS RD STE 120, SAINT LOUIS, MO 63141-8221
(314) 251-6986
(314) 251-5712
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2018005317
MO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/14/2017
Last updated
01/29/2026
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