Provider Demographics
NPI:1700545654
Name:KELLEY, JEAN E (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:REKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-206-3700
Mailing Address - Fax:314-206-3708
Practice Address - Street 1:1150 GRAHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-206-3800
Practice Address - Fax:314-209-3992
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044682163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health