Healthcare Provider Details

I. General information

NPI: 1023528064
Provider Name (Legal Business Name): MELISSA NASH EVERAGE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST BLDG 760
MAXWELL AFB AL
36112-6027
US

IV. Provider business mailing address

42D MEDICAL GROUP 300 S. TWINING ST., BLDG 760
MAXWELL AFB AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5200
  • Fax:
Mailing address:
  • Phone: 334-953-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number082498-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number082498-21
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number082498-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: