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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528433430 | NPPES |
| Missouri | MEDICAID | 420030952 |
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