Healthcare Provider Details

I. General information

NPI: 1225722804
Provider Name (Legal Business Name): MELEA MCCORMICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 S 31ST ST
FORT SMITH AR
72908-7555
US

IV. Provider business mailing address

6108 S 31ST ST
FORT SMITH AR
72908-7555
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-9355
  • Fax:
Mailing address:
  • Phone: 479-242-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213043
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: