Healthcare Provider Details

I. General information

NPI: 1457722365
Provider Name (Legal Business Name): MELINDA R MCCLELLAN APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA R MUNCY APRN CNP

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 5TH ST NE STE 16
BARBERTON OH
44203-3017
US

IV. Provider business mailing address

201 5TH ST NE STE 16
BARBERTON OH
44203-3017
US

V. Phone/Fax

Practice location:
  • Phone: 330-615-3031
  • Fax: 234-312-2427
Mailing address:
  • Phone: 330-615-3031
  • Fax: 234-312-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18292
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18292-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: