MEDICARE: MELONIE POWELL

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
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1902481955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELONIE POWELL

Provider Business Mailing Address
First Line	:	8123 DELMAR BLVD STE 200
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3729
Country	:	US
Telephone Number	:	314-498-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	8123 DELMAR BLVD STE 200
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3729
Country	:	US
Telephone Number	:	314-498-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	06/28/2021

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Directions to “ MELONIE POWELL ” Practice Location

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