Individual
KELLY K GOWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNPC-AG
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
(314) 525-1728
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
(314) 525-1728
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2018034800
MO
363LG0600X
Gerontology Nurse Practitioner
2018034800
MO
Other
Enumeration date
09/25/2018
Last updated
09/26/2018
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