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Individual

KELLY ANN NICHOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5000
Mailing address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041459011
IL
163W00000X
Registered Nurse
2005023391
MO
363LF0000X
Family Nurse Practitioner
Primary
2019038073
MO

Other

Enumeration date
09/04/2019
Last updated
08/06/2025
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