Provider Demographics
NPI:1568455574
Name:KLAHS, ALFRED L (ANP)
Entity Type:Individual
Prefix:MS
First Name:ALFRED
Middle Name:L
Last Name:KLAHS
Suffix:
Gender:M
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8233
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2500
Mailing Address - Fax:314-747-2598
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 6A/6B/12A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2500
Practice Address - Fax:314-747-2598
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO135396363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1568455574Medicaid
MOQ28925Medicare UPIN
MOP00237537OtherRR MEDICARE