Healthcare Provider Details

I. General information

NPI: 1821492638
Provider Name (Legal Business Name): MELISSA ASHLEY SPRINKLE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ASHLEY CLARK

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST SUITE A-1
CLOVIS NM
88101-4087
US

IV. Provider business mailing address

2000 W 21ST ST SUITE A-1
CLOVIS NM
88101-4087
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-8055
  • Fax: 575-763-3351
Mailing address:
  • Phone: 575-762-8055
  • Fax: 575-763-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNP-02494
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: