Healthcare Provider Details

I. General information

NPI: 1831045988
Provider Name (Legal Business Name): MELISSA CHARLEEN KIRKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 HARDWICK DR APT 526
NEW PORT RICHEY FL
34653-6278
US

IV. Provider business mailing address

7925 HARDWICK DR APT 526
NEW PORT RICHEY FL
34653-6278
US

V. Phone/Fax

Practice location:
  • Phone: 727-260-2725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11045769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: