Provider Demographics
NPI:1336276096
Name:PATEL, KELLY A (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:10777 SUNSET OFFICE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1019
Mailing Address - Country:US
Mailing Address - Phone:314-822-5900
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-925-4700
Practice Address - Fax:314-925-4716
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004007219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner