Healthcare Provider Details

I. General information

NPI: 1184230203
Provider Name (Legal Business Name): MELINDA HALTERMAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 08/16/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLAZA EAST BLVD STE 303
EVANSVILLE IN
47715-2871
US

IV. Provider business mailing address

8844 IDAHO DR
NEWBURGH IN
47630-9028
US

V. Phone/Fax

Practice location:
  • Phone: 812-491-1307
  • Fax: 812-473-1035
Mailing address:
  • Phone: 812-453-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010396A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71010396A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: