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Individual

KELLY ELIZABETH STOLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
621 S NEW BALLAS RD, SUITE 4006B, SAINT LOUIS, MO 63141-8232
(314) 251-6486
Mailing address
621 S NEW BALLAS RD, SUITE 4006B, SAINT LOUIS, MO 63141-8232
(314) 251-6486

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003719
IL
363A00000X
Physician Assistant
Primary
2010011164
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00860308
RAILROAD MEDICARE
MO
Enumeration date
04/03/2010
Last updated
11/27/2018
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