Healthcare Provider Details

I. General information

NPI: 1215624002
Provider Name (Legal Business Name): MELISSA FERRELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9780 S ESTRELLA PKWY
GOODYEAR AZ
85338-7114
US

IV. Provider business mailing address

9780 S ESTRELLA PKWY
GOODYEAR AZ
85338-7114
US

V. Phone/Fax

Practice location:
  • Phone: 623-474-8101
  • Fax: 623-285-2626
Mailing address:
  • Phone: 623-474-8101
  • Fax: 623-285-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number290777
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: