Healthcare Provider Details

I. General information

NPI: 1669561411
Provider Name (Legal Business Name): LINDSAY R MELSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD HICKINGBOTHAM OUTPAITENT CENTER
LITTLE ROCK AR
72205-6324
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DRIVE SUITE 200
LITTLE ROCK AR
72211-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-1902
  • Fax: 501-202-1512
Mailing address:
  • Phone: 501-812-7587
  • Fax: 501-812-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA02926
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: