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General NPI Number Information
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NPI Number | 1487480752
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Entity Type | Individual
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Provider Name | KELECHI UCHE UDUMA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1 HAIRPIN DRIVE
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City | EDWARDSVILLE
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State | IL
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Zip | 62026-0001
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Country | US
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Telephone | 314-745-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 168 BEHLMANN MEADOWS WAY
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City | FLORISSANT
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State | MO
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Zip | 63034-2863
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Country | US
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Telephone | 314-745-4673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025034856
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2019030421
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 041561779
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License Number State | IL
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