Provider Demographics
NPI:1477768422
Name:KEIM, JANET M (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:KEIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2622
Mailing Address - Country:US
Mailing Address - Phone:314-533-4770
Mailing Address - Fax:314-533-3226
Practice Address - Street 1:3200 CHOUTEAU AVE
Practice Address - Street 2:CASA DE SALUD
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103
Practice Address - Country:US
Practice Address - Phone:314-762-1251
Practice Address - Fax:314-771-6848
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011022109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0237409OtherANCC CERTIF (ADULT NP)
0246073OtherANCC CERTIF (GERONT NP)
0237409OtherANCC CERTIF (ADULT NP)