Healthcare Provider Details

I. General information

NPI: 1407775406
Provider Name (Legal Business Name): KELLI LEONTINE JUNGEWAELTER DNP, WHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKVIEW PL
SAINT LOUIS MO
63110-1038
US

IV. Provider business mailing address

434 MORGAN WOODS DR
FENTON MO
63026-5532
US

V. Phone/Fax

Practice location:
  • Phone: 866-867-3627
  • Fax:
Mailing address:
  • Phone: 314-403-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number104119474
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: