Provider Demographics
NPI:1790336048
Name:BROWN, MELISSA LYNN (MPH, CHES, RD, LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MPH, CHES, RD, LD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:RICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, CHES
Mailing Address - Street 1:3117 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1212
Mailing Address - Country:US
Mailing Address - Phone:314-652-3663
Mailing Address - Fax:
Practice Address - Street 1:3117 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1212
Practice Address - Country:US
Practice Address - Phone:314-652-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019028295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered