Healthcare Provider Details

I. General information

NPI: 1437633716
Provider Name (Legal Business Name): MELISSA L. BROCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA L. CLAYTON APRN

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6339
  • Fax:
Mailing address:
  • Phone: 314-251-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2018035749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: