Provider Demographics
NPI:1952169591
Name:KEGIN, ELLEN BLAKE (AGNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:BLAKE
Last Name:KEGIN
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-8103
Mailing Address - Fax:314-996-3230
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV IM GENERAL MED, STE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-996-8103
Practice Address - Fax:314-996-3230
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2024007848363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology