Healthcare Provider Details

I. General information

NPI: 1477293967
Provider Name (Legal Business Name): MELISSA PAIGE HARKINS APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

2747 RUTGER ST
SAINT LOUIS MO
63104-1931
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax:
Mailing address:
  • Phone: 314-775-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021003416
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: