Provider Demographics
NPI:1447893003
Name:KELLEY, EMILY MORGAN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MORGAN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10235 TRAIL TREE FARM RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:MO
Mailing Address - Zip Code:63648-2100
Mailing Address - Country:US
Mailing Address - Phone:573-330-5155
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTHTOWNE DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-5729
Practice Address - Country:US
Practice Address - Phone:573-438-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019042808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics