Healthcare Provider Details

I. General information

NPI: 1285185223
Provider Name (Legal Business Name): MELISSA KLUKKERT VANARTSDALEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN KLUKKERT DMSC, PA-C

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH OPC 41 BOX 15
APO AE
09461-5115
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH OPC 41 BOX 15
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8010
  • Fax:
Mailing address:
  • Phone: 314-226-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10.879386-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: