Provider Demographics
NPI:1033314976
Name:ODONNELL-STOCKTON, KELLIE M (NP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:M
Last Name:ODONNELL-STOCKTON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:201 BJC SAINT PETERS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3091
Mailing Address - Country:US
Mailing Address - Phone:636-916-8200
Mailing Address - Fax:636-916-8239
Practice Address - Street 1:201 BJC SAINT PETERS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3091
Practice Address - Country:US
Practice Address - Phone:636-916-8200
Practice Address - Fax:636-916-8239
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000172033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily