Healthcare Provider Details

I. General information

NPI: 1558349928
Provider Name (Legal Business Name): MELINDA JANINE ARMSTRONG PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KWAJALEIN HOSPITAL
APO AP
96555
US

IV. Provider business mailing address

P.O. BOX 142465
FAYETTEVILLE GA
30214
US

V. Phone/Fax

Practice location:
  • Phone: 805-355-2223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003870
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-693
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1089
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: