MEDICARE: MELINDA BLAKE APRN

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	363LF0000X	Family Nurse Practitioner	236795	AR

General Provider Information

NPI Number	:	1801726674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA BLAKE APRN

Provider Business Mailing Address
First Line	:	9001 JENNY LIND RD STE 3
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-385-9001
Fax Number	:	479-668-3699

Provider Business Practice Location Address
First Line	:	9001 JENNY LIND RD STE 3
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-385-9001
Fax Number	:	479-668-3699

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ MELINDA BLAKE APRN” Practice Location

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