Healthcare Provider Details

I. General information

NPI: 1982982542
Provider Name (Legal Business Name): MELANIE RENEE NEW APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E JOHNSON AVE
JONESBORO AR
72401-8413
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3625
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberS02256 CNS
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: