Provider Demographics
NPI:1922522184
Name:BICKEL, CHARISSA MARIE (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:MARIE
Last Name:BICKEL
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PMHNP
Mailing Address - Street 1:1430 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2360
Mailing Address - Country:US
Mailing Address - Phone:314-645-6840
Mailing Address - Fax:314-628-1046
Practice Address - Street 1:1585 WOODLAKE DR STE 111
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-221-8177
Practice Address - Fax:314-628-1046
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012035357163W00000X
MO2024039909363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse