Provider Demographics
NPI:1154636579
Name:DONZE, KELLY A (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:DONZE
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINTE GENEVIEVE DR
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1434
Mailing Address - Country:US
Mailing Address - Phone:573-883-4477
Mailing Address - Fax:573-883-4472
Practice Address - Street 1:800 SAINTE GENEVIEVE DR
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1434
Practice Address - Country:US
Practice Address - Phone:573-883-5715
Practice Address - Fax:573-883-2463
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012010344363LW0102X
IL209.008269367A00000X
MO2011001942367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health