Healthcare Provider Details

I. General information

NPI: 1831902220
Provider Name (Legal Business Name): MALAIKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 HIGHWAY N STE 506
SAINT CHARLES MO
63304-8032
US

IV. Provider business mailing address

5377 HIGHWAY N STE 506
SAINT CHARLES MO
63304-8032
US

V. Phone/Fax

Practice location:
  • Phone: 636-489-3555
  • Fax: 636-489-3555
Mailing address:
  • Phone: 636-489-3555
  • Fax: 636-489-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE N MEPUKORI
Title or Position: OWNER AND CEO
Credential:
Phone: 636-489-3555