Healthcare Provider Details

I. General information

NPI: 1396187662
Provider Name (Legal Business Name): MELISSA BARRON THARP MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE STE C
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

3500 COMANCHE RD NE STE C
ALBUQUERQUE NM
87107-4546
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-7200
  • Fax:
Mailing address:
  • Phone: 505-998-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69964
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903267
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: