Provider Demographics
NPI:1801234174
Name:MACARTHUR, KELLY MACKENZIE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MACKENZIE
Last Name:MACARTHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WESTWOOD COUNTRY CLB
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2411
Mailing Address - Country:US
Mailing Address - Phone:888-785-3376
Mailing Address - Fax:866-326-6671
Practice Address - Street 1:555 N NEW BALLAS RD STE 160
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:888-785-3376
Practice Address - Fax:866-326-6671
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036158005207N00000X, 207ND0101X
MO2019020870207NS0135X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology