Provider Demographics
NPI:1871144832
Name:KELLAHAN, SARA RANAE (AGNP)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:RANAE
Last Name:KELLAHAN
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-514-3500
Mailing Address - Fax:314-514-3555
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DEPT ORTHOPAEDIC SURGERY, STE 110/210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-514-3500
Practice Address - Fax:314-514-3555
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019037649363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420077904Medicaid