Provider Demographics
NPI:1467831883
Name:KELTNER, GRACE ANNE (NP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:KELTNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANNE
Other - Last Name:HODILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 PLAZA 94
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7405
Mailing Address - Country:US
Mailing Address - Phone:636-387-5698
Mailing Address - Fax:
Practice Address - Street 1:20 PLAZA 94
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7405
Practice Address - Country:US
Practice Address - Phone:636-387-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76651363L00000X
MO2020019125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner