Healthcare Provider Details

I. General information

NPI: 1205157807
Provider Name (Legal Business Name): MELISSA JOY KIEFER-MCELWRATH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA J KIEFER NP

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5772
  • Fax: 314-996-7691
Mailing address:
  • Phone: 314-996-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2000163049
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2013009190
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: