Individual
MS. KELSIE MARIE MENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
4500 FOREST PARK AVE, DEPT NEUROLOGICAL SURGERY, STE 1B, SAINT LOUIS, MO 63108-2114
(314) 362-3577
(314) 362-2107
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-3577
(314) 362-2107
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2016001344
MO
363LA2100X
Acute Care Nurse Practitioner
2016001344
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420028400
—
MO
Enumeration date
09/03/2015
Last updated
04/17/2025
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