Provider Demographics
NPI:1376097329
Name:WATSON, KELSIE ANNE (FNP, DNP)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:ANNE
Other - Last Name:CARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:969 N MASON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6338
Mailing Address - Country:US
Mailing Address - Phone:314-996-3434
Mailing Address - Fax:
Practice Address - Street 1:969 N MASON RD STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-996-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018000703363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily