Brooke Lauren Meyer, RN, MSN, CPNP
Individual provider Active NPI Pediatric Nurse Practitioner · O Fallon, MO
NPI 1104216142 · NPPES record last updated Feb 7, 2019
Key facts
- NPI
- 1104216142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 2015000990 (MO)
- Practice address
- 300 Winding Woods Dr Ste 101
O Fallon, MO 63366-4771 - Phone
- (636) 978-7902
- NPI assigned
- Jan 29, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150311001736 | MO | Practitioner - Nurse Practitioner | 2769708692 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015000990 | MO | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic East Communities | Current |
Accepting new patients | |
| Tiger Pediatrics LLC | Past |
Accepting new patients |
Locations
300 Winding Woods Dr
Ste 120
O Fallon, MO 63366
Phone (636) 614-3280
2223 Technology Dr
Ste 10
O Fallon, MO 63368
Phone (636) 240-9896
300 Winding Woods Dr
Ste 101
O Fallon, MO 63366
Phone (636) 978-7902
621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192
621 S New Ballas Rd
Ste 537A
Saint Louis, MO 63141
Phone (314) 251-6990
1502 W Meyer Rd
Wentzville, MO 63385
Phone (636) 698-6200
Interoperability endpoints
- bskowera94138@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 2015000990 | MO | Yes |
Addresses
Primary practice location
300 Winding Woods Dr Ste 101
O Fallon, MO 63366-4771
Mailing address
300 Winding Woods Dr Ste 101
O Fallon, MO 63366-4771
Other providers in O Fallon, MO
- Gabrielle Elizabeth Mertz
- Allison Mesler
- Meta Pharmacy Solutions
- Metro Area Surgical Assistants, LLC
- Metro Area Surgical Assistants, LLC
- Christine Meyer
- Madison Meyer
- Melissa Meyer
- Rabya R Mian
- Michael a. Williams, DC
All providers in O Fallon, MO · Pediatric Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.