Individual
ALYXANDREA MARIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
777 CRAIG RD, SAINT LOUIS, MO 63141-7276
(231) 970-0460
Mailing address
1441 BROCK ST, SAINT LOUIS, MO 63139-3617
(231) 970-0460
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704313495
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2024000884
MO
Other
Enumeration date
03/10/2021
Last updated
02/02/2024
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