Provider Demographics
NPI:1437477932
Name:BIRD, MERIELLE NICOLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MERIELLE
Middle Name:NICOLE
Last Name:BIRD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-454-2523
Practice Address - Street 1:13001 N OUTER 40 RD
Practice Address - Street 2:DIV NEUROLOGY PEDIATRICS, STE 1A
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-454-2523
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010006172363LF0000X
IL209.018255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420070865Medicaid