Individual
KELLI P WIETHUCHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4921 PARKVIEW PL, SAINT LOUIS, MO 63110-1032
(314) 454-8134
Mailing address
1149 WOODGATE DR, KIRKWOOD, MO 63122-1029
(314) 346-7042
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201603977
MO
363L00000X
Nurse Practitioner
Primary
2016039777
MO
363L00000X
Nurse Practitioner
209023299
IL
363LF0000X
Family Nurse Practitioner
2016039777
MO
Other
Enumeration date
05/15/2017
Last updated
05/13/2025
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