Individual
DR. KELLY N BOTTERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4444 FOREST PARK AVE, STE 2600, SAINT LOUIS, MO 63108-2212
(314) 286-1700
(314) 286-1777
Mailing address
4511 FOREST PARK AVE, STE 4300, SAINT LOUIS, MO 63108-2138
(314) 286-1700
(314) 408-2756
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
R3P75
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203692009
—
MO
Enumeration date
06/17/2006
Last updated
11/15/2021
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