Healthcare Provider Details

I. General information

NPI: 1669922068
Provider Name (Legal Business Name): MELANIE HUFF ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 207B
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE. 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7960
  • Fax: 314-989-0235
Mailing address:
  • Phone: 314-996-7960
  • Fax: 314-989-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2016036661
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2010003376
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: