MEDICARE: MRS. MELISSA J ALLISON ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	A01819	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y072	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1013901214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA J ALLISON ANP

Provider Business Mailing Address
First Line	:	127 SCENIC VALLEY LOOP
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113
Country	:	US
Telephone Number	:	501-851-1270
Fax Number	:	501-666-3956

Provider Business Practice Location Address
First Line	:	4300 W 7TH ST
Second Line	:	CENTRAL AR VETERANS HEALTHCARE SYSTEM
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5446
Country	:	US
Telephone Number	:	501-257-6671
Fax Number	:	501-257-6225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	08/06/2010

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