Individual
KELSEY ILL LOETHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
812 N KEENE ST, COLUMBIA, MO 65201-6633
(573) 817-3000
(573) 876-6950
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2020041866
MO
Other
Enumeration date
11/04/2020
Last updated
10/01/2024
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