Provider Demographics
NPI:1205993169
Name:AMERSON, KELLY (WHNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:AMERSON
Suffix:
Gender:F
Credentials:WHNP
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Mailing Address - Street 1:4901 FOREST PARK AVE
Mailing Address - Street 2:MSC 8064-37-1005
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1495
Mailing Address - Country:US
Mailing Address - Phone:314-362-4211
Mailing Address - Fax:314-747-6722
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV OBGYN FAMILY PLANNING, STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-4211
Practice Address - Fax:888-315-6494
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO2000151478363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420012144Medicaid