MEDICARE: MELISSA COKER

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	133V00000X	Registered Dietitian	1173	OK

General Provider Information

NPI Number	:	1952915001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA COKER

Provider Business Mailing Address
First Line	:	1122 GIBRALTAR POINT DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-5037
Country	:	US
Telephone Number	:	405-388-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 GIBRALTAR POINT DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-5037
Country	:	US
Telephone Number	:	405-388-3347
Fax Number	:

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

Provider Enumeration Date	:	09/06/2020
Last Update Date	:	09/06/2020

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Directions to “ MELISSA COKER ” Practice Location

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