MEDICARE: MELISSA KLUKKERT VANARTSDALEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	10.879386-1206	UT

General Provider Information

NPI Number	:	1285185223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KLUKKERT VANARTSDALEN PA-C

Provider Business Mailing Address
First Line	:	48 MDG/RAF LAKENHEATH
Second Line	:	OPC 41 BOX 15
City	:	APO
State	:	AE
Zip	:	09461-5115
Country	:	US
Telephone Number	:	314-226-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	48TH MDG/RAF LAKENHEATH
Second Line	:	OPC 41 BOX 15
City	:	APO
State	:	AE
Zip	:	09461-5115
Country	:	US
Telephone Number	:	314-226-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	06/15/2026

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