Individual
MATTHEW CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10004 KENNERLY RD, STE 364B, SAINT LOUIS, MO 63128-2141
(314) 525-4429
(314) 525-7260
Mailing address
10004 KENNERLY RD, STE 364B, SAINT LOUIS, MO 63128-2141
(314) 525-4429
(314) 525-7260
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
2013037719
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2013037719
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770913089
—
MO
Enumeration date
11/22/2013
Last updated
03/14/2017
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