1770559668 NPI number — MISS KELLY E COMPAS AGACNP-BC

Table of content: MISS KELLY E COMPAS AGACNP-BC (NPI 1770559668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770559668 NPI number — MISS KELLY E COMPAS AGACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMPAS
Provider First Name:
KELLY
Provider Middle Name:
E
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
AGACNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770559668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JEFFERSON BARRACKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63125-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-437-9212
Provider Business Mailing Address Fax Number:
314-289-7905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JEFFERSON BARRACKS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-437-9212
Provider Business Practice Location Address Fax Number:
314-289-7905
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  131702 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 131702 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 424892818 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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