Healthcare Provider Details

I. General information

NPI: 1093632077
Provider Name (Legal Business Name): CHLOE EDEN NELSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 JANIS LYNN CT
KIRKWOOD MO
63122-3716
US

IV. Provider business mailing address

1025 JANIS LYNN CT
KIRKWOOD MO
63122-3716
US

V. Phone/Fax

Practice location:
  • Phone: 224-522-7594
  • Fax:
Mailing address:
  • Phone: 224-522-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026024584
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: