Individual
COLLEEN R KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
3651 COLLEGE BLVD, LEAWOOD, KS 66211-1910
(913) 319-7633
(913) 253-1764
Mailing address
12639 OLD TESSON RD, SUITE 100, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
119557
MO
363AS0400X
Surgical Physician Assistant
Primary
1500630
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40122016
BCBS-KC
KS
Enumeration date
06/30/2006
Last updated
05/17/2019
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