Provider Demographics
NPI:1316683253
Name:FOUTZ, MELISSA ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:FOUTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SLAPSHOT DR
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-2699
Mailing Address - Country:US
Mailing Address - Phone:636-578-4549
Mailing Address - Fax:
Practice Address - Street 1:1101 SLAPSHOT DR
Practice Address - Street 2:
Practice Address - City:FORISTELL
Practice Address - State:MO
Practice Address - Zip Code:63348-2699
Practice Address - Country:US
Practice Address - Phone:636-578-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF04220327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily