Individual provider · Type 1 NPI
Heather Christine Licata, PNP
Pediatric Nurse Practitioner · St. Louis, MO
NPI number
1225544109
Active
Practice location
615 S New Ballas Rd Ste 120
St. Louis, MO 63141-8221
Fax (314) 251-5712
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 2018005317 (MO) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1225544109
Heather Christine Licata, PNP's National Provider Identifier is 1225544109, issued on Dec 14, 2017. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in St. Louis, MO. The record was last updated on Jan 29, 2026.