Provider Demographics
NPI:1316387509
Name:KELLEN, ALESHIA MICHELLE (WHNP)
Entity Type:Individual
Prefix:
First Name:ALESHIA
Middle Name:MICHELLE
Last Name:KELLEN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-9007
Mailing Address - Country:US
Mailing Address - Phone:417-269-7900
Mailing Address - Fax:417-269-7990
Practice Address - Street 1:1000 E PRIMROSE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5154
Practice Address - Country:US
Practice Address - Phone:417-269-7900
Practice Address - Fax:417-269-7990
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022749363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420008732Medicaid
MO1316387509Medicaid