Healthcare Provider Details

I. General information

NPI: 1265044747
Provider Name (Legal Business Name): MELYSSA LEWIS DNP, BSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELYSSA CARLSON

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 N MAY AVE
OKLAHOMA CITY OK
73120-2712
US

IV. Provider business mailing address

9480 N MAY AVE
OKLAHOMA CITY OK
73120-2712
US

V. Phone/Fax

Practice location:
  • Phone: 405-876-7876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number225129
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number259493
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number259493
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60945219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: