Individual
MS. CHONTAY L MCKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201-1129
(618) 482-6959
(618) 482-8311
Mailing address
1013 TIMBERWOOD TRAILS DR, FLORISSANT, MO 63031-7511
(314) 313-2804
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015043224
MO
363LF0000X
Family Nurse Practitioner
209014333
IL
363LP2300X
Primary Care Nurse Practitioner
2015043224
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
07/01/2016
Last updated
04/07/2020
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