Active NPI
Kelly Marie Rudroff, RN, MSN
- Family Nurse Practitioner
- Saint Louis, MO
National Provider Identifier
1609216159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2016042952
- Practice address
- 915 N Grand Blvd
Saint Louis, MO 63106 - Phone
- (314) 652-4100
- NPI assigned
- Jun 28, 2013
- Last updated
- Apr 14, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2016042952 | MO | Primary |
| Registered Nurse | 163W00000X | 900243 | MS |
Addresses
Primary practice location
915 N Grand Blvd
Saint Louis, MO 63106
Mailing address
2909 Shenandoah Ave
Saint Louis, MO 63104-1739
Phone (314) 583-7698
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 900243 | MS | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vpa PC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients |
Locations
8706 Manchester Rd
Ste 106
Saint Louis, MO 63144
Phone (314) 961-3570
Organizations & group practices 2
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": "1372377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523664000000",
"number": "1609216159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2909 SHENANDOAH AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041739",
"telephone_number": "314-583-7698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 N GRAND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "63106",
"telephone_number": "314-652-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDROFF",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RN, MSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-28",
"last_updated": "2018-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2016042952",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MS",
"license": "900243",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.