MEDICARE: MELISSA LOUISE CHICK NP

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	363L00000X	Nurse Practitioner	A005890	AR

General Provider Information

NPI Number	:	1144702689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LOUISE CHICK NP

Provider Business Mailing Address
First Line	:	PO BOX 776075
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6075
Country	:	US
Telephone Number	:	479-573-3042
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 PHOENIX AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5083
Country	:	US
Telephone Number	:	479-573-3042
Fax Number	:

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

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	08/31/2018

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