Individual
KELLIE WASSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
500 MEDICAL DR, WENTZVILLE, MO 63385-3421
(636) 327-1000
Mailing address
2 CITYPLACE DR FL 2, SAINT LOUIS, MO 63141-7390
(314) 914-2717
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2019002386
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2024040280
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420150983
—
MO
Enumeration date
09/30/2024
Last updated
05/16/2026
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