Walther, Kongkeo Thiky

Walther, Kongkeo Thiky is an individual health care provider with primary practice located at 12774 Boenker Ln , Bridgeton MO 63044-2436. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Walther, Kongkeo Thiky can be contacted via phone (314) 291-7997.

Contact Information

Primary practice address
12774 Boenker Ln Bridgeton MO 63044-2436
Phone: (314) 291-7997
Fax: (314) 739-1471
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 2015040094 Missouri

Profile Details

NPI number 1528433430
LBN Legal business name Walther, Kongkeo Thiky
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2015
Last updated Dec 21st, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528433430 NPPES
Missouri MEDICAID 420030952

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