Mangold, Kelly Renee
Mangold, Kelly Renee is an individual health care provider with primary practice located at 3 Scarlet Oak Ct , Lake St Louis MO 63367-2130. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Mangold, Kelly Renee can be contacted via phone (312) 919-6286.Contact Information
Primary practice address
3 Scarlet Oak Ct
Lake St Louis MO 63367-2130
Phone: (312) 919-6286
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered | 367500000X | 2010005602 | Missouri |
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered | 367500000X | 6708 | North Carolina |
Profile Details
NPI number | 1477876803 |
---|---|
LBN Legal business name | Mangold, Kelly Renee |
Credentials | Certified Registered Nurse Anesthetist (CRNA) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 12th, 2010 |
Last updated | Jun 28th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1477876803 | NPPES |
Missouri | MEDICAID | 600420070 |
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