Healthcare Provider Details

I. General information

NPI: 1033282728
Provider Name (Legal Business Name): MELODYE LYNN GILBERT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 817 GLENN HIGHWAY
GLENNALLEN AK
99588-0589
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-3203
  • Fax: 907-822-5805
Mailing address:
  • Phone: 907-822-3203
  • Fax: 907-822-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055921
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005055
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number488
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: