Individual
MRS. MELLISA DAWN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1420 US HIGHWAY 61, FESTUS, MO 63028-4108
(636) 543-2230
Mailing address
1420 US HIGHWAY 61, FESTUS, MO 63028-4108
(636) 543-2230
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023002795
MO
Other
Enumeration date
01/31/2023
Last updated
04/24/2025
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