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NPI Code Detail

MEDICARE: MS. MICHELLE RENEE MARTIN PNP

MEDICARE: MS. MICHELLE RENEE MARTIN PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse131957MO
2363LP0200XPediatric Nurse Practitioner2019012307MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679521520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE RENEE MARTIN PNP
Provider Business Mailing Address
First Line : 1032 CROSSWINDS CT
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-4836
Country : US
Telephone Number : 844-853-8937
Fax Number : 636-332-1401
Provider Business Practice Location Address
First Line : 1032 CROSSWINDS CT
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-4836
Country : US
Telephone Number : 844-853-8937
Fax Number : 636-332-1401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/11/2025

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