Healthcare Provider Details

I. General information

NPI: 1154862225
Provider Name (Legal Business Name): KELLY ANN ESPOSITO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N MASON RD STE 115
SAINT LOUIS MO
63141-6361
US

IV. Provider business mailing address

1040 N MASON RD STE 115
SAINT LOUIS MO
63141-6361
US

V. Phone/Fax

Practice location:
  • Phone: 314-542-0606
  • Fax:
Mailing address:
  • Phone: 314-542-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2017006134
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: