Healthcare Provider Details

I. General information

NPI: 1588198246
Provider Name (Legal Business Name): CHANEY MARIE BELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANEY MARIE ROBERTS NP

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 02/03/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 DELMAR BLVD SUITE B
ST LOUIS MO
63112
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 844-776-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015346
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017002553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: