Healthcare Provider Details

I. General information

NPI: 1336066562
Provider Name (Legal Business Name): KELSEY TSUKAYAMA-JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 410752
SAINT LOUIS MO
63141-0752
US

IV. Provider business mailing address

PO BOX 410752
SAINT LOUIS MO
63141-0752
US

V. Phone/Fax

Practice location:
  • Phone: 314-412-1039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number2021006079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: