Healthcare Provider Details

I. General information

NPI: 1588062517
Provider Name (Legal Business Name): MELISSA NICELEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEAN DR
MOUNT ORAB OH
45154-3505
US

IV. Provider business mailing address

100 DEAN DR
MOUNT ORAB OH
45154-3505
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-0035
  • Fax: 937-444-0036
Mailing address:
  • Phone: 937-444-0035
  • Fax: 937-444-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.381708
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: