Healthcare Provider Details

I. General information

NPI: 1710338298
Provider Name (Legal Business Name): KATIE LAUREN MELCHER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS1500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: