Provider Demographics
NPI:1609879337
Name:WHITSON, MELISSA A (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:WHITSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HAMPTON VILLAGE PLZ 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2128
Mailing Address - Country:US
Mailing Address - Phone:314-351-2004
Mailing Address - Fax:314-351-0347
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2128
Practice Address - Country:US
Practice Address - Phone:314-351-2004
Practice Address - Fax:314-351-0347
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015366208000000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008015366OtherSTATE LICENSE NUMBER
MO1578711420OtherTYPE 2 NPI
MO1609879337Medicaid
MO1609879337Medicaid
MOFW1052668OtherDEA