Individual provider Active NPI

Kelcey A Depass, FNP

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1437614823
Registry record updated Feb 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017044249 Issued in MO
Practice address
3930 S Broadway
Saint Louis, MO 63118-4626
Phone
(314) 898-1700
NPI assigned
Feb 10, 2019
Last updated
Feb 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2017044249 MO Primary

Addresses

Primary practice location

3930 S Broadway
Saint Louis, MO 63118-4626

Mailing address

2650 Pennsylvania Ave
Saint Louis, MO 63118-1310
Phone (240) 338-6759

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190415002839 MO Practitioner - Nurse Practitioner 5294076592 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Affinia Healthcare Current Accepting new patients

Locations

1717 Biddle St
Saint Louis, MO 63106
Phone (314) 814-8515

4414 N Florissant Ave
Saint Louis, MO 63107
Phone (314) 814-8515

Interoperability endpoints

  • Direct secure messaging: kelcey.depass.p1@direct.affiniahealthcare.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549756800000",
    "number": "1437614823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 PENNSYLVANIA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631181310",
            "telephone_number": "240-338-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 S BROADWAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631184626",
            "telephone_number": "314-898-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPASS",
        "first_name": "KELCEY",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-10",
        "last_updated": "2019-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017044249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.