MEDICARE: ERIN KEHOE ASTA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	2020018631	MO

General Provider Information

NPI Number	:	1396362224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN KEHOE ASTA APRN

Provider Business Mailing Address
First Line	:	12973 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6149
Country	:	US
Telephone Number	:	314-619-8967
Fax Number	:

Provider Business Practice Location Address
First Line	:	12973 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6149
Country	:	US
Telephone Number	:	314-548-2172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	04/20/2021

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