Provider Demographics
NPI:1831242858
Name:PATTERSON, MELODY ANN (APRN, BC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 HARVEST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5993
Mailing Address - Country:US
Mailing Address - Phone:636-940-0126
Mailing Address - Fax:
Practice Address - Street 1:1901 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1325
Practice Address - Country:US
Practice Address - Phone:314-512-7601
Practice Address - Fax:314-512-7612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO061336163WP0807X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ47134Medicare UPIN