Provider Demographics
NPI:1134609324
Name:WOOD, MEGAN ROCHELLE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ROCHELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ROCHELLE
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:10420 OLD OLIVE STREET RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5937
Mailing Address - Country:US
Mailing Address - Phone:314-504-4698
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3130
Practice Address - Country:US
Practice Address - Phone:636-432-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF02181208363LF0000X
MO2018038493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily