Healthcare Provider Details

I. General information

NPI: 1063077204
Provider Name (Legal Business Name): KELSEY LYN ROWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-268-2700
  • Fax:
Mailing address:
  • Phone: 314-454-6050
  • Fax: 855-887-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2023009184
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023009184
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.249600
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number2023009184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: