Individual
KELLY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6000
Mailing address
910 N 4TH ST, FESTUS, MO 63028-1705
(314) 650-4229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20190321601
MO
363LF0000X
Family Nurse Practitioner
Primary
2019032160
MO
Other
Enumeration date
09/26/2022
Last updated
10/30/2024
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