Healthcare Provider Details

I. General information

NPI: 1902761075
Provider Name (Legal Business Name): CONVERSE PMHNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 SCHATZ POINTE DR
CENTERVILLE OH
45459-3824
US

IV. Provider business mailing address

68 TAMARACK TRL
SPRINGBORO OH
45066-1464
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-9841
  • Fax:
Mailing address:
  • Phone: 937-902-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JANE RENNER
Title or Position: PMHNP
Credential: PMHNP
Phone: 937-438-9841