Healthcare Provider Details

I. General information

NPI: 1770381428
Provider Name (Legal Business Name): MELISSA ANN FALLAT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BRIDGEPORT WAY W STE A
UNIVERSITY PLACE WA
98466-4600
US

IV. Provider business mailing address

909 FORREST PARK DR
FIRCREST WA
98466-6808
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-6760
  • Fax:
Mailing address:
  • Phone: 253-583-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70124581
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60991785
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: