Mcdermott, Kelly Eileen

Mcdermott, Kelly Eileen is an individual health care provider with primary practice located at 4921 Parkview Pl Div Im General Med, Ste 12B, Saint Louis MO 63110-1032. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is her primary health care specialty. Mcdermott, Kelly Eileen can be contacted via phone (314) 747-3969.

Contact Information

Primary practice address
4921 Parkview Pl Div Im General Med, Ste 12B Saint Louis MO 63110-1032
Phone: (314) 747-3969
Fax: (314) 996-3230
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 2023001041 Missouri
Allopathic & Osteopathic Physicians / General Practice 208D00000X 2023001041 Missouri

Profile Details

NPI number 1619593258
LBN Legal business name Mcdermott, Kelly Eileen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 19th, 2020
Last updated Apr 25th, 2024 - 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1619593258 NPPES
Missouri MEDICAID 200085095

Popular Providers