Healthcare Provider Details

I. General information

NPI: 1144638842
Provider Name (Legal Business Name): MRS. MELISSA RENEE BRUEGGEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA NAVAS-BRUEGGEMANN

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3464
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-0288
  • Fax: 859-341-7482
Mailing address:
  • Phone: 859-341-0288
  • Fax: 859-341-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1125425
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008843
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: