Healthcare Provider Details

I. General information

NPI: 1598231904
Provider Name (Legal Business Name): ALLISON ANNE MALLETTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ALLISON ANNE MALLETTE

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8134
  • Fax:
Mailing address:
  • Phone: 314-454-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2018035534
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013025085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: