Provider Demographics
NPI:1619399003
Name:HART, MELINDA CAROL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:CAROL
Last Name:HART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:660-338-5909
Mailing Address - Fax:660-338-5903
Practice Address - Street 1:108 MARKET ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MO
Practice Address - Zip Code:65254-1053
Practice Address - Country:US
Practice Address - Phone:660-338-5909
Practice Address - Fax:660-338-5903
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014001558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily