MEDICARE: KELSEY CONLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2010025594	MO

General Provider Information

NPI Number	:	1962907782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY CONLEY

Provider Business Mailing Address
First Line	:	2839 HOWARD ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-2027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 HOWARD ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-2027
Country	:	US
Telephone Number	:	314-238-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2018
Last Update Date	:	03/25/2018

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Directions to “ KELSEY CONLEY ” Practice Location

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