Healthcare Provider Details

I. General information

NPI: 1588488829
Provider Name (Legal Business Name): YOLANDA YVETTE KEELY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LOCUST ST UNIT 306
SAINT LOUIS MO
63103-1824
US

IV. Provider business mailing address

1600 LOCUST ST UNIT 306
SAINT LOUIS MO
63103-1824
US

V. Phone/Fax

Practice location:
  • Phone: 314-581-8280
  • Fax:
Mailing address:
  • Phone: 314-581-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number2024001957
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number2024001957
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: