Provider Demographics
NPI:1871126391
Name:LONERGAN, KELSEY (PMHNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 DELMAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-531-3072
Practice Address - Street 1:5647 DELMAR BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2617
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-531-3072
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020614363LP0200X
MO2021050418363LP0808X, 363LP0200X
MO2023044236363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics