Provider Demographics
NPI:1770559668
Name:COMPAS, KELLY E (AGACNP-BC)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:E
Last Name:COMPAS
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Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-4545
Mailing Address - Fax:314-996-4546
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 359C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-4545
Practice Address - Fax:314-996-4546
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-02-20
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Provider Licenses
StateLicense IDTaxonomies
MO131702363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424892818Medicaid
MO819584175Medicare ID - Type Unspecified
MOP03174Medicare UPIN