Healthcare Provider Details

I. General information

NPI: 1194223891
Provider Name (Legal Business Name): MELISSA ANN GIBBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CAMPBELL APRN

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 E JOHNSON AVE STE B
JONESBORO AR
72405-1808
US

IV. Provider business mailing address

500 SW 7TH ST STE A205
RENTON WA
98057-2983
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 509-491-3031
Mailing address:
  • Phone: 509-222-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005468
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA005468
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: