Healthcare Provider Details

I. General information

NPI: 1255997771
Provider Name (Legal Business Name): MELISSA DAWN ESPINOSA NCPRSS, BHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N 31ST ST
CLINTON OK
73601-9116
US

IV. Provider business mailing address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5108
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-9766
  • Fax: 580-323-5635
Mailing address:
  • Phone: 580-323-9766
  • Fax: 580-323-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: