Individual
MRS. KELLY SUE KUNKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, FNP-BC
Contact information
Practice address
3655 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 268-7700
(314) 268-7711
Mailing address
3655 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 257-8515
(314) 268-7711
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016042747
MO
363LF0000X
Family Nurse Practitioner
209015441
IL
Other
Enumeration date
02/08/2017
Last updated
11/05/2020
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