Provider Demographics
NPI:1780385724
Name:MENDES, AUDREY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:MENDES
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:ESCHBACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2480 EXECUTIVE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5608
Mailing Address - Country:US
Mailing Address - Phone:636-402-9949
Mailing Address - Fax:
Practice Address - Street 1:2480 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5608
Practice Address - Country:US
Practice Address - Phone:636-402-9949
Practice Address - Fax:636-206-8634
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023009849363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health