Individual
KELBY LYNN WITHROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13861 MANCHESTER RD, BALLWIN, MO 63011-4503
(636) 556-0114
Mailing address
4603 MATTIS RD, SAINT LOUIS, MO 63128-3015
(618) 316-8321
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
2022009903
MO
Other
Enumeration date
02/07/2019
Last updated
04/18/2023
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