Individual
KATHLEEN MILES NIKODYM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
400 1ST CAPITOL DR STE 100, SAINT CHARLES, MO 63301-2881
(636) 332-8455
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2002004796
MO
363AS0400X
Surgical Physician Assistant
2002004796
MO
Other
Enumeration date
10/18/2006
Last updated
07/23/2025
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