Healthcare Provider Details

I. General information

NPI: 1316387509
Provider Name (Legal Business Name): ALESHIA MICHELLE KELLEN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST SUITE 400
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7900
  • Fax: 417-269-7990
Mailing address:
  • Phone: 417-269-7900
  • Fax: 417-269-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2013022749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: