Provider Demographics
NPI:1528544459
Name:OWENS, MELINDA JOYCE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JOYCE
Last Name:OWENS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ATHENS
Mailing Address - State:IL
Mailing Address - Zip Code:62264-1020
Mailing Address - Country:US
Mailing Address - Phone:618-521-7096
Mailing Address - Fax:
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5395
Practice Address - Fax:314-268-6459
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018007539363LP0200X
IL209017870363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics