Provider Demographics
NPI:1679998272
Name:KELLER, ANGELA PROST (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PROST
Last Name:KELLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:PROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1008 S SPRING AVE STE 3819
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-4010
Mailing Address - Fax:314-977-3495
Practice Address - Street 1:1225 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-5200
Practice Address - Fax:314-977-3495
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013044509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily