Provider Demographics
NPI:1144425083
Name:BOUTWELL, KAYLEA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KAYLEA
Middle Name:MARIE
Last Name:BOUTWELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2570
Mailing Address - Fax:314-336-2571
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 360
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2570
Practice Address - Fax:314-336-2571
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2009025407207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology