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General NPI Number Information
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NPI Number | 1609427178
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Entity Type | Individual
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Provider Name | KELLY LYNN MUNSON
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 1 JEFFERSON BARRACKS DR
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City | LEMAY
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State | MO
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Zip | 63125-4181
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Country | US
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Telephone | 314-210-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 TUSCANY WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-0501
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Country | US
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Telephone | 314-304-0379
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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 | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | 2010023603
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License Number State | MO
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