Individual
LAUREN KATHERINE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 233-7750
Mailing address
2232 S GRAND BLVD APT 221, SAINT LOUIS, MO 63104-1666
(913) 601-9669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009876
IL
363A00000X
Physician Assistant
2023028270
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/12/2022
Last updated
08/10/2023
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