Healthcare Provider Details

I. General information

NPI: 1477978054
Provider Name (Legal Business Name): WHITNEY MELTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

IV. Provider business mailing address

3443 HARRISON ST
BATESVILLE AR
72501-8820
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1635
  • Fax: 870-793-3196
Mailing address:
  • Phone: 870-698-1635
  • Fax: 870-793-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004035
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: