Individual provider · Type 1 NPI

Carley Michele Roth

Nurse Practitioner · Fenton, MO

NPI number 1639034424 Active

Practice location

1055 Bowles Ave Ste 200
Fenton, MO 63026-2308

Mailing address

PO Box 955534
St. Louis, MO 63195-5534

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X2026003319 (MO)
Family Nurse Practitioner 363LF0000X2026003319 (MO)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1639034424

Carley Michele Roth's National Provider Identifier is 1639034424, issued on Dec 23, 2025. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Fenton, MO. The record was last updated on Apr 21, 2026.