Healthcare Provider Details

I. General information

NPI: 1679998272
Provider Name (Legal Business Name): ANGELA PROST KELLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MICHELLE PROST FNP

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE STE 3819
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-5200
  • Fax: 314-977-3495
Mailing address:
  • Phone: 314-977-4010
  • Fax: 314-977-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013044509
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: