Individual
MARY DEANE KITCHURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
15945 CLAYTON RD STE 120A, BALLWIN, MO 63011-2490
(636) 256-5000
(636) 256-5100
Mailing address
920 ROCKY COVE DR, LABADIE, MO 63055-1988
(314) 365-4767
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2025040004
MO
Other
Enumeration date
06/18/2025
Last updated
10/03/2025
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