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General NPI Number Information
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NPI Number | 1801963715
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Entity Type | Individual
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Provider Name | KELLY K RANEY RN, FNP, CS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 12639 OLD TESSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2786
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Country | US
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Telephone | 314-849-0311
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Fax | 314-849-4423
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Provider Business Mailing Address
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Address Line | 1165 N BUTTERFIELD RD
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City | BOLIVAR
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State | MO
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Zip | 65613-1056
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Country | US
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Telephone | 417-777-8131
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Fax | 417-777-8892
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 099454
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License Number State | MO
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