Healthcare Provider Details

I. General information

NPI: 1235840570
Provider Name (Legal Business Name): MELISSA ELAINE HERST APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 E SHAWNEE RD
MUSKOGEE OK
74403-1530
US

IV. Provider business mailing address

2414 E SHAWNEE RD
MUSKOGEE OK
74403-1530
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3699
  • Fax:
Mailing address:
  • Phone: 918-577-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number210979
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR0067184
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: