Healthcare Provider Details

I. General information

NPI: 1912828690
Provider Name (Legal Business Name): MELISSA ADAMSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 GOETHE AVE
SAINT LOUIS MO
63116-1205
US

IV. Provider business mailing address

4820 GOETHE AVE
SAINT LOUIS MO
63116-1205
US

V. Phone/Fax

Practice location:
  • Phone: 281-770-0935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number2021029096
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: