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NPI Code Detail

MEDICARE: MELISSA LEE BOUNDS NP

MEDICARE: MELISSA LEE BOUNDS 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
1363L00000XNurse Practitioner2018009351MO
2363LF0000XFamily Nurse Practitioner209-015573IL

General Provider Information

NPI Number : 1831630458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LEE BOUNDS NP
Provider Business Mailing Address
First Line : 2250 N ILLINOIS AVE
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-5612
Country : US
Telephone Number : 618-833-1691
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4713
Country : US
Telephone Number : 618-798-3066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2017
Last Update Date : 09/08/2021

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