MS. KELLY A WALLACE


Address: 615 S New Ballas Rd, Sjmmc Dept of Anes, Saint Louis, MO 63141-8221
Phone: 6363869224

MS. KELLY A WALLACE (NPI# 1669464350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1669464350
Entity Type Individual
Full Name MS. KELLY A WALLACE
Credential CRNA
Practice Address 615 S New Ballas Rd
Sjmmc Dept of Anes
Saint Louis
MO 63141-8221
Mailing Address 339 Consort Dr
Ballwin
MO 63011-4439
Practice Telephone 6363869224
Practice Fax Number 6363867679
Mailing Telephone 6363869224
Mailing Fax Number 6363867679
Enumeration Date 2005-08-18
Last Update Date 2010-06-29
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 367500000X Nurse Anesthetist, Certified Registered 121517 MO Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MO 916940117 05

Other Providers KELLY WALLACE

NPI Name Taxonomy Address Enumeration
1124675749 Kelly Love Wallace Counselor 2817 Stonebrook Rd, Edmond, OK 73003-2105 2019-08-19
1841704467 Kelly M Wallace Social Worker 11 Mills Rd, Middletown, NY 10941-1018 2017-11-17
1760727283 Kelly Wallace Physical Therapist 7160 Tchulahoma Rd Ste 4, Southaven, MS 38671-9266 2012-12-10
1194892810 Kelly Wallace Physical Therapist 8619 Broadway St Ste 200, Pearland, TX 77584-8496 2006-11-29
1184696023 Kelly Wallace Physical Therapist 13390 Ne 23rd St, Choctaw, OK 73020-8622 2006-02-05

Office Location

Street Address 615 S NEW BALLAS RD
SJMMC DEPT OF ANES
City SAINT LOUIS
State MO
Zip Code 63141-8221

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780689182 Robert W Allen Anesthesiology 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2005-06-14
1033722061 Ashley Maull Nurse Practitioner 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-08-28
1508476367 Ryan Nathan Student in an Organized Health Care Education/Training Program 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-08-06
1992315857 Corey Weicht Nurse Practitioner 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-08-05
1063021905 Alexandria Colleen Grodie Nurse Practitioner 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-07-27
1396353892 Fahad Bin Tahir Internal Medicine 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-07-21
1588281307 Alexander Cai Dentist 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-06-26
1083231070 Lauren Gonzalez Anesthesiologist Assistant 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-06-25
1780200253 Matthew Davis Internal Medicine 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-06-22
1902422421 Megan Reidy Landis Family Medicine 615 S New Ballas Rd, Saint Louis, MO 63141-8221 2020-06-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1679102842 Noor Ramadan Pharmacist 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 2020-04-08
1497381206 Washington University Durable Medical Equipment & Medical Supplies 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 2020-03-13
1154956498 Ashleigh Clendenny Physician Assistant Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 2020-03-06
1801429410 Emili Lou Haley Registered Nurse 650 Maryville Drive, St Louis, MO 63141 2020-02-21
1629553110 Rebecca Kathleen Pike Social Worker West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 2018-10-01
1649756099 River City Sedation Associates, LLC Nurse Anesthetist, Certified Registered 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 2018-07-18
1205333952 Ear Care and Hearing of St. Louis Hearing Aid Equipment 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 2018-04-10
1659897486 Erin Goodman Physical Therapist 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 2017-08-14
1093230450 Center for Urologic Surgery LLC Clinic/Center 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 2017-08-07
1871016105 Jacob Farley Tanner Specialist/Technologist 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 2017-07-19
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Taxonomy Information

Taxonomy Code 367500000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Anesthetist, Certified Registered

Taxonomy Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1649756099 River City Sedation Associates, LLC Nurse Anesthetist, Certified Registered 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 2018-07-18
1548767783 Chynna Janae Lorusso Nurse Anesthetist, Certified Registered 5321 Shaw Ave, Saint Louis, MO 63110-3023 2018-04-12
1245644806 Nicole Fadler Stevens Nurse Anesthetist, Certified Registered 1 Barnes Jewish Hospital Plz Dept Of, Saint Louis, MO 63110-1003 2014-06-11
1467711226 Jacob William Pressler Nurse Anesthetist, Certified Registered 725 Tuxedo Blvd, Saint Louis, MO 63119-1946 2012-05-14
1861718165 Janna Sue Ford Nurse Anesthetist, Certified Registered 1304 Millbay Ct, Saint Louis, MO 63129-3171 2010-04-12
1407895030 Scott Jeffrey Weinerth Nurse Anesthetist, Certified Registered 6122 Terri Lynn Dr, Saint Louis, MO 63123-1678 2006-06-06
1518913938 Annie Mcnulty-jennings Nurse Anesthetist, Certified Registered 10535 Landseer Dr, Saint Louis, MO 63136-4530 2006-05-26
1417906579 Diane Richter Nurse Anesthetist, Certified Registered 3015 N. Ballas Rd., Saint Louis, MO 63160-0001 2006-05-08
1699723510 Mark Erwin Holthaus Nurse Anesthetist, Certified Registered 10811 Kennerly Rd, Saint Louis, MO 63128-2016 2006-05-04
1477539351 Theresa Stearns Nurse Anesthetist, Certified Registered 5571 Bartmer Ave., Saint Louis, MO 63112-3406 2005-12-21
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Competitor

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City SAINT LOUIS
Zip Code 63141

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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