Healthcare Provider Details

I. General information

NPI: 1780910083
Provider Name (Legal Business Name): MELISSA ANNE SICARD PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD DIV PED ENDOCRINOLOGY AND DIABETES
CHESTERFIELD MO
63017-5941
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6051
  • Fax: 314-454-6225
Mailing address:
  • Phone: 314-454-6051
  • Fax: 314-454-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2002019668
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2002019668
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: