Mangold, Kelly Renee

Mangold, Kelly Renee is an individual health care provider with primary practice located at 3 Scarlet Oak Ct , Lake St Louis MO 63367-2130. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Mangold, Kelly Renee can be contacted via phone (312) 919-6286.

Contact Information

Primary practice address
3 Scarlet Oak Ct Lake St Louis MO 63367-2130
Phone: (312) 919-6286
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 2010005602 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 6708 North Carolina

Profile Details

NPI number 1477876803
LBN Legal business name Mangold, Kelly Renee
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 12th, 2010
Last updated Jun 28th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477876803 NPPES
Missouri MEDICAID 600420070

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