Healthcare Provider Details

I. General information

NPI: 1659086502
Provider Name (Legal Business Name): MELISSA ANNE HUTSELL APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 E JOYCE BLVD STE 5
FAYETTEVILLE AR
72703-5390
US

IV. Provider business mailing address

800 CUSTER ST
PRAIRIE GROVE AR
72753-3165
US

V. Phone/Fax

Practice location:
  • Phone: 479-841-7795
  • Fax:
Mailing address:
  • Phone: 803-460-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number120194
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: