Individual
CARLEY MICHELE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 BOWLES AVE STE 200, FENTON, MO 63026-2308
(636) 496-3900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
163WN0800X
Neuroscience Registered Nurse
Primary
2021024598
MO
363L00000X
Nurse Practitioner
Primary
2026003319
MO
363LF0000X
Family Nurse Practitioner
2026003319
MO
Other
Enumeration date
12/23/2025
Last updated
04/21/2026
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