Healthcare Provider Details

I. General information

NPI: 1861656043
Provider Name (Legal Business Name): MS. MELANIE A DUMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W 23RD AVE
PINE BLUFF AR
71601-6304
US

IV. Provider business mailing address

PO BOX 2545
PINE BLUFF AR
71613-2545
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-7679
  • Fax:
Mailing address:
  • Phone: 870-534-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: