Healthcare Provider Details
I. General information
NPI: 1134609324
Provider Name (Legal Business Name): MEGAN ROCHELLE WOOD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/16/2018
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
851 E 5TH ST STE 308
WASHINGTON MO
63090-3130
US
IV. Provider business mailing address
10420 OLD OLIVE STREET RD STE 205
SAINT LOUIS MO
63141-5937
US
V. Phone/Fax
- Phone: 636-432-5500
- Fax:
- Phone: 314-504-4698
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | F02181208 |
| License Number State | MO |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 2018038493 |
| License Number State | MO |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: