Healthcare Provider Details

I. General information

NPI: 1871144832
Provider Name (Legal Business Name): SARA RANAE KELLAHAN AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2019
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N MASON RD DEPT ORTHOPAEDIC SURGERY, STE 110/210
SAINT LOUIS MO
63141-6431
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-3500
  • Fax: 314-878-7678
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-878-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019037649
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2019037649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: