=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902761075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONVERSE PMHNP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7901 SCHATZ POINTE DR
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-438-9841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68 TAMARACK TRL
-----------------------------------------------------
City | SPRINGBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45066-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-902-3498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP
-----------------------------------------------------
Name | MELISSA JANE RENNER
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 937-438-9841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------