=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023528064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA NASH EVERAGE NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2017
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 TWINING ST BLDG 760
-----------------------------------------------------
City | MAXWELL AFB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36112-6027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-953-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42D MEDICAL GROUP 300 S. TWINING ST., BLDG 760
-----------------------------------------------------
City | MAXWELL AFB
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36112-6027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-953-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 082498-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | 082498-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 082498-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------