Healthcare Provider Details

I. General information

NPI: 1891625596
Provider Name (Legal Business Name): QUALIA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N WARSON RD
SAINT LOUIS MO
63132-1111
US

IV. Provider business mailing address

7827 TOWN SQUARE AVE STE 104-1043
O FALLON MO
63368-7197
US

V. Phone/Fax

Practice location:
  • Phone: 636-238-7027
  • Fax:
Mailing address:
  • Phone: 636-238-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY MCKINNEY
Title or Position: OWNER
Credential:
Phone: 636-238-7027