Healthcare Provider Details

I. General information

NPI: 1114454048
Provider Name (Legal Business Name): MELANIE ANN DAVIDSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE ANN BROWN RN

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BATTLEFIELD ST STE 124
SPRINGFIELD MO
65807-5208
US

IV. Provider business mailing address

900 E BATTLEFIELD ST STE 124
SPRINGFIELD MO
65807-5208
US

V. Phone/Fax

Practice location:
  • Phone: 417-986-1289
  • Fax:
Mailing address:
  • Phone: 417-986-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017014483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: