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General NPI Number Information
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NPI Number | 1578338828
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Entity Type | Individual
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Provider Name | KELLI MARIE DIX-ROSEN
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 10279 BUSINESS 21
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City | HILLSBORO
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State | MO
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Zip | 63050-3598
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Country | US
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Telephone | 636-677-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2246 CARLTON DR
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City | FESTUS
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State | MO
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Zip | 63028-3806
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Country | US
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Telephone | 636-208-1378
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2024000069
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License Number State | MO
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