=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780354092
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA ANN KNOX FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 09/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 247 BLUFFS AVE STE 102
-----------------------------------------------------
City | ELKO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89801-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-738-1212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 ABEYTA DR
-----------------------------------------------------
City | SPRING CREEK
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89815-5442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 826538
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------