Healthcare Provider Details

I. General information

NPI: 1609491828
Provider Name (Legal Business Name): KELSEY ANN BUSKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 02/02/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL CB 8116
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL CB 8116
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6018
  • Fax: 844-621-4392
Mailing address:
  • Phone: 314-454-6018
  • Fax: 844-621-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022008808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: