Provider Demographics
NPI:1528594355
Name:EDWARDS, MELISSA JOY (ACNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOY
Last Name:EDWARDS
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Gender:F
Credentials:ACNP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8007-0029-11
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-647-2098
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE 7A, 7B, 7C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:800-647-2098
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-09-21
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Provider Licenses
StateLicense IDTaxonomies
MO2017014475363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420045086Medicaid