Provider Demographics
NPI:1407455421
Name:GREIN, KELLY RENEE (APRN-FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RENEE
Last Name:GREIN
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 POINTE BASSE DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1820
Mailing Address - Country:US
Mailing Address - Phone:573-883-2782
Mailing Address - Fax:
Practice Address - Street 1:575 PINE DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1446
Practice Address - Country:US
Practice Address - Phone:573-883-7474
Practice Address - Fax:573-883-7647
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034791363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily