Healthcare Provider Details

I. General information

NPI: 1639014681
Provider Name (Legal Business Name): KELLY ANN LEIWEKE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SUNRISE SCHOOL RD
DE SOTO MO
63020-5113
US

IV. Provider business mailing address

3800 SUNRISE SCHOOL RD
DE SOTO MO
63020-5113
US

V. Phone/Fax

Practice location:
  • Phone: 314-440-9909
  • Fax:
Mailing address:
  • Phone: 314-440-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2023045582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: