Healthcare Provider Details

I. General information

NPI: 1619912797
Provider Name (Legal Business Name): ST LOUIS NEPHROLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 361B
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

PO BOX 840132
KANSAS CITY MO
64184-0132
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3449
  • Fax: 314-843-8762
Mailing address:
  • Phone: 314-843-3449
  • Fax: 314-843-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GOPAL KRISHNAN
Title or Position: CEO
Credential: MD
Phone: 314-843-3449