Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Deane Kitchura, PA

Individual provider Physician Assistant · NPI 1538056148

Mary Deane Kitchura, PA is a Physician Assistant in Ballwin, Missouri. Qualified in 2025, 1 year ago. Licensed in Missouri.

Years since qualifying
1
Licensed in
MO
In the registry since
2025
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

15945 Clayton Rd Ste 120A
Ballwin, MO 63011-2490
Phone: (636) 256-5000
Fax: (636) 256-5100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2025040004 (MO)

Record details

NPI number1538056148
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 18, 2025
Last updated in NPPESOctober 3, 2025
Certification dateOctober 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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