Individual
CLAYTON EDWARD MCKIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
969 N MASON RD, STE 160, SAINT LOUIS, MO 63141-6338
(314) 996-3434
(314) 996-3595
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(314) 996-3434
(314) 996-3595
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2013011243
MO
Other
Enumeration date
06/12/2013
Last updated
06/12/2013
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