KELLEY JOHANNA BASS

ST. LOUIS, MO
NPI1316112295
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363AS0400X Physician Assistant, Surgical
(Licence: MO  2008013830)
Enumeration Date2008-04-23
Last Update Date2008-06-12
Business Address
Mrs. KELLEY JOHANNA BASS PA-C
621 S. NEW BALLAS RD. SUITE 297-A
ST. LOUIS, MO 63141-8200
Phone number: 314-251-6364
Mailing Address
Mrs. KELLEY JOHANNA BASS PA-C
15317 COVENTRY WOODS CT
CHESTERFIELD, MO 63017-7500
Phone number: 636-220-2309
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