Healthcare Provider Details

I. General information

NPI: 1407588643
Provider Name (Legal Business Name): MEGAN RENEE CROWE PMHNPBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN RENEE KERBER RN

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S FARRAR DR STE 109
CAPE GIRARDEAU MO
63701-4912
US

IV. Provider business mailing address

106 S FARRAR DR STE 109
CAPE GIRARDEAU MO
63701-4912
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-7055
  • Fax: 573-334-7961
Mailing address:
  • Phone: 573-334-7055
  • Fax: 573-334-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2015023323
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022025020
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: