Provider Demographics
NPI:1770559668
Name:COMPAS, KELLY E (AGACNP-BC)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:E
Last Name:COMPAS
Suffix:
Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:1 JEFFERSON BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4181
Mailing Address - Country:US
Mailing Address - Phone:314-437-9212
Mailing Address - Fax:314-289-7905
Practice Address - Street 1:1 JEFFERSON BARRACKS
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-437-9212
Practice Address - Fax:314-289-7905
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2025-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO131702363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424892818Medicaid
MO819584175Medicare ID - Type Unspecified
MOP03174Medicare UPIN