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Individual

MRS. KELLEY JOHANNA BASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
621 S. NEW BALLAS RD., SUITE 297-A, ST. LOUIS, MO 63141-8200
(314) 251-6364
(314) 251-7897
Mailing address
15317 COVENTRY WOODS CT, CHESTERFIELD, MO 63017-7500
(636) 220-2309

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2008013830
MO

Other

Enumeration date
04/23/2008
Last updated
06/12/2008
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