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General NPI Number Information
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NPI Number | 1225552326
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Entity Type | Individual
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Provider Name | ALYSSA M MELLENCAMP NP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 3105 N BEND RD
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City | HEBRON
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State | KY
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Zip | 41048-8523
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Country | US
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Telephone | 615-425-4201
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 ELM HILL PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0031263
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007434A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3017660
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License Number State | KY
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