MATTHEW CHARLES (NPI# 1770913089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770913089 |
| Entity Type | Individual |
| Full Name | MATTHEW CHARLES |
| Practice Address |
10004 Kennerly Rd Ste 364b Saint Louis MO 63128-2141 |
| Practice Telephone | 3145254429 |
| Practice Fax Number | 3145257260 |
| Mailing Telephone | 3145254429 |
| Mailing Fax Number | 3145257260 |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2017-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
2013037719 | MO | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
2013037719 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1770913089 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134206808 | Matthew J Charles | Chiropractor | 96 Union St, Easthampton, MA 01027-1450 | 2006-11-01 |
| 1255504684 | Matthew John Charles | Anesthesiology | Unm Hospital, 2211 Lomas Blvd Ne, Albuquerque, NM 87131-0001 | 2008-04-07 |
| Street Address |
10004 KENNERLY RD STE 364B |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053317313 | Sylvia Ann Steiling | Surgery | 10004 Kennerly Rd, Ste 137a, Saint Louis, MO 63128-2140 | 2005-06-22 |
| 1376166066 | Nhs South LLC | Internal Medicine | 10004 Kennerly Rd, Saint Louis, MO 63128-2141 | 2020-05-28 |
| 1932690567 | Kristin Leigh Wall | Registered Nurse | 10004 Kennerly Rd, Saint Louis, MO 63128-2141 | 2018-05-18 |
| 1447795695 | Laura Michler | Nurse Practitioner | 10004 Kennerly Rd, Ste 115a, Saint Louis, MO 63128-2141 | 2016-12-27 |
| 1346796562 | Jennifer Lynn Seib | Nurse Practitioner | 10004 Kennerly Rd, Ste. 255a, Saint Louis, MO 63128-2141 | 2016-08-28 |
| 1528415536 | Community & Long-term Care Psychiatry LLC | Behavioral Analyst | 10004 Kennerly Rd, Ste 362b, Saint Louis, MO 63128-2141 | 2016-05-19 |
| 1083081004 | Frank H Gafford Md, PC | Internal Medicine | 10004 Kennerly Rd, Suite 283b, Saint Louis, MO 63128-2141 | 2015-08-25 |
| 1710375340 | Sabina Smajis | Nurse Practitioner | 10004 Kennerly Rd, Saint Louis, MO 63128-2141 | 2015-01-05 |
| 1962810952 | St. Anthony's Physician Organization | Internal Medicine | 10004 Kennerly Rd, Suite 200a, Saint Louis, MO 63128-2141 | 2014-07-23 |
| 1457766255 | St. Anthony's Physician Organization | Obstetrics & Gynecology | 10004 Kennerly Rd, Ste 395b, Saint Louis, MO 63128-2141 | 2014-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740807825 | Aldijana Sacic | Nurse Practitioner | 8525 Glenwood Dr, Saint Louis, MO 63126-1849 | 2020-07-06 |
| 1619433125 | Kacey Alexandra Patterson | Nurse Practitioner | 4219 Laclede Ave Ste B, Saint Louis, MO 63108-2814 | 2019-02-20 |
| 1245708239 | Anne Leslie Thatcher | Nurse Practitioner | 915 N Grand Blvd Ofc C123, Saint Louis, MO 63106-1621 | 2018-11-07 |
| 1194271163 | Amanda Maria Kearney | Nurse Practitioner | 555 N New Ballas Rd Ste 220, Saint Louis, MO 63141 | 2016-08-30 |
| 1033722061 | Ashley Maull | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-08-28 |
| 1992315857 | Corey Weicht | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-08-05 |
| 1063021905 | Alexandria Colleen Grodie | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-07-27 |
| 1841810025 | Innovative Mental Health Services | Nurse Practitioner | 12747 Olive Blvd Ste 300, Saint Louis, MO 63141-6269 | 2020-04-17 |
| 1386284990 | Virginia Cozon Lanzotti | Nurse Practitioner | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2020-01-11 |
| 1700423076 | Faisal Matar | Nurse Practitioner | 12855 N 40 Dr, Saint Louis, MO 63141-8622 | 2019-12-05 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.