Provider Demographics
NPI:1831446863
Name:SMITH, MELINDA MICHELE (DNP, PMHNP, ACNS)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, PMHNP, ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 DRY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4146
Mailing Address - Country:US
Mailing Address - Phone:330-501-9448
Mailing Address - Fax:330-793-8585
Practice Address - Street 1:5669 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2615
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-241-1185
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 13241-NS364SA2200X
MO20210443385363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241705Medicaid
OHH133081Medicare PIN
OH0241705Medicaid