Provider Demographics
NPI:1720583982
Name:MEYER, KELLY LACEY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LACEY
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-2683
Mailing Address - Fax:314-454-4633
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED NEWBORN MEDICINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2683
Practice Address - Fax:314-454-4633
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021016510208000000X, 2080N0001X, 2080N0001X, 208000000X
KS94-09698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200057294Medicaid