Healthcare Provider Details

I. General information

NPI: 1861303232
Provider Name (Legal Business Name): GABRIELLE HANCHER MELTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 KLEMM ST
SAINT LOUIS MO
63110-3964
US

IV. Provider business mailing address

2358 KLEMM ST
SAINT LOUIS MO
63110-3964
US

V. Phone/Fax

Practice location:
  • Phone: 618-420-5138
  • Fax:
Mailing address:
  • Phone: 618-420-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021027014
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: