Healthcare Provider Details

I. General information

NPI: 1912650193
Provider Name (Legal Business Name): KELLI ROWLAND DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 W OSAGE ST
PACIFIC MO
63069-1101
US

IV. Provider business mailing address

2120 W OSAGE ST
PACIFIC MO
63069-1101
US

V. Phone/Fax

Practice location:
  • Phone: 636-257-4660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022002801
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: