Healthcare Provider Details

I. General information

NPI: 1124469887
Provider Name (Legal Business Name): MELISSA L. ALUMBAUGH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N EDMONDS AVE
MC CRORY AR
72101-8279
US

IV. Provider business mailing address

117 S 2ND ST PO BOX 497
AUGUSTA AR
72006-2309
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-5411
  • Fax: 870-731-5431
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003911
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: