Healthcare Provider Details

I. General information

NPI: 1306304605
Provider Name (Legal Business Name): MEGHANN BRANHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SOUTHFORK RD STE 280
SAINT LOUIS MO
63128-3287
US

IV. Provider business mailing address

12700 SOUTHFORK RD STE 280
SAINT LOUIS MO
63128-3287
US

V. Phone/Fax

Practice location:
  • Phone: 314-892-6565
  • Fax:
Mailing address:
  • Phone: 314-892-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2019004293
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: