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General NPI Number Information
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NPI Number | 1659086502
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Entity Type | Individual
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Provider Name | MELISSA ANNE HUTSELL APRN CNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 10/08/2023
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Provider Practice Location Address
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Address Line | 2907 E JOYCE BLVD STE 5
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5390
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Country | US
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Telephone | 479-841-7795
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Fax |
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Provider Business Mailing Address
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Address Line | 800 CUSTER ST
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City | PRAIRIE GROVE
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State | AR
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Zip | 72753-3165
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Country | US
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Telephone | 803-460-2342
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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 | 120194
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License Number State | AR
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