Charles, Matthew

Charles, Matthew is an individual health care provider with primary practice located at 10004 Kennerly Rd Ste 364B, Saint Louis MO 63128-2141. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Psychiatric/Mental Health, Adult, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Charles, Matthew can be contacted via phone (314) 525-4429.

Contact Information

Primary practice address
10004 Kennerly Rd Ste 364B Saint Louis MO 63128-2141
Phone: (314) 525-4429
Fax: (314) 525-7260
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health, Adult 163WP0809X 2013037719 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 2013037719 Missouri

Profile Details

NPI number 1770913089
LBN Legal business name Charles, Matthew
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2013
Last updated Mar 14th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770913089 NPPES
Missouri MEDICAID 1770913089

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