Healthcare Provider Details

I. General information

NPI: 1083153787
Provider Name (Legal Business Name): ALANTE Q GHANNAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALANTE QUANAI FLETCHER

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD STE 200
SAINT CHARLES MO
63304-8788
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-0325
  • Fax: 636-695-0326
Mailing address:
  • Phone: 314-645-3743
  • Fax: 314-647-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017000787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: