MEDICARE: MELINDA RADER PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP8620	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277.002586	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710379227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA RADER PMHNP-BC

Provider Business Mailing Address
First Line	:	3008 HAPPY LANDING DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6259
Country	:	US
Telephone Number	:	253-346-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 HAPPY LANDING DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6259
Country	:	US
Telephone Number	:	253-346-0133
Fax Number	:

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

Provider Enumeration Date	:	02/21/2015
Last Update Date	:	05/31/2024

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