=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437192283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OKSANA Y. MELNYK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 05/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9600 LILE DR STE 210
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-6344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-217-0500
-----------------------------------------------------
Fax | 501-217-9400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13712 SAINT MICHAEL DR
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-6203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-413-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | E-4859
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------