Healthcare Provider Details

I. General information

NPI: 1619733292
Provider Name (Legal Business Name): MELISSA JO FRAZIER DNP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 10TH ST
ATLANTIC IA
50022-1936
US

IV. Provider business mailing address

1501 E 10TH ST
ATLANTIC IA
50022-1936
US

V. Phone/Fax

Practice location:
  • Phone: 712-243-2850
  • Fax:
Mailing address:
  • Phone: 712-243-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12230745
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: