Provider Demographics
NPI:1780910083
Name:SICARD, MELISSA ANNE (PNP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:SICARD
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6051
Mailing Address - Fax:314-454-6225
Practice Address - Street 1:13001 N OUTER 40 RD
Practice Address - Street 2:DIV PED ENDOCRINOLOGY AND DIABETES
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-454-6051
Practice Address - Fax:314-454-6225
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019668363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424144103Medicaid
ILENROLLEDMedicaid