Healthcare Provider Details

I. General information

NPI: 1194261743
Provider Name (Legal Business Name): LINDSEY KERLEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

752 PECAN HILL DR
SAINT CHARLES MO
63304-5046
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-4466
  • Fax:
Mailing address:
  • Phone: 314-229-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016022543
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: