Healthcare Provider Details

I. General information

NPI: 1427539030
Provider Name (Legal Business Name): KELLY NICOLE SCHELICH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 KEATON CROSSING BLVD STE 102
O FALLON MO
63368-8219
US

IV. Provider business mailing address

3351 SW 3RD ST
LEES SUMMIT MO
64081-4006
US

V. Phone/Fax

Practice location:
  • Phone: 636-329-9077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209025367
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018025391
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: