Healthcare Provider Details

I. General information

NPI: 1023820032
Provider Name (Legal Business Name): HEALTHCARE MENTORSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 205
SAINT LOUIS MO
63141-8670
US

IV. Provider business mailing address

12747 OLIVE BLVD STE 300
CREVE COEUR MO
63141-6269
US

V. Phone/Fax

Practice location:
  • Phone: 314-325-6940
  • Fax:
Mailing address:
  • Phone: 573-587-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY LEE MORGANITE
Title or Position: CEO
Credential: NP
Phone: 573-587-5356