Healthcare Provider Details

I. General information

NPI: 1952828584
Provider Name (Legal Business Name): MEGHAN CRISMON BEZAIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 11/18/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MASON RD DIV SURG CT ADULT CARDIO, STE 100
SAINT LOUIS MO
63141-6666
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8234-05-02
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7260
  • Fax: 314-747-0917
Mailing address:
  • Phone: 314-362-7260
  • Fax: 314-362-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022033501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: