Individual
REBECCA THERESA MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
736 MARCO VALLEY CT, FENTON, MO 63026-5318
(314) 413-2187
Mailing address
736 MARCO VALLEY CT, FENTON, MO 63026-5318
(314) 413-2187
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2019029631
MO
Other
Enumeration date
06/05/2020
Last updated
09/11/2025
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