Individual
MS. ELLEN BLAKE KEGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1044 N MASON RD, DIV IM GENERAL MED, STE 330, SAINT LOUIS, MO 63141-6431
(314) 996-8103
(314) 996-3230
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 996-8103
(314) 996-3230
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2024007848
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420141659
—
MO
Enumeration date
03/08/2024
Last updated
04/17/2025
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