Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Kelly A Wallace, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1669464350

MS. Kelly A Wallace, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Saint Louis, Missouri. Qualified in 1991, 35 years ago. Practices with Gateway Gastroenterology Inc, a 25-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
35
Licensed in
MO
In the registry since
2005
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

615 S New Ballas Rd Sjmmc Dept OF Anes
Saint Louis, MO 63141-8221
Phone: (636) 386-9224
Fax: (636) 386-7679
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 17298 N Outer 40 Rd Ste 200, Chesterfield, MO 63005-1456 — (314) 529-4900

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 121517 (MO)

Record details

NPI number1669464350
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNA
Sole proprietorYes
NPI enumeratedAugust 18, 2005
Last updated in NPPESJuly 1, 2026
Certification dateJuly 1, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 1991 (35 years in practice)
Group practice Gateway Gastroenterology Inc — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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