Provider Demographics
NPI:1063929248
Name:LIVINGSTON, MELISSA MICHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 CALLE BELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7055
Mailing Address - Country:US
Mailing Address - Phone:575-491-4764
Mailing Address - Fax:
Practice Address - Street 1:2100 S TRIVIZ DR STE F
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-0601
Practice Address - Country:US
Practice Address - Phone:575-556-1849
Practice Address - Fax:575-532-2030
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-03472OtherNEW MEXICO CNP LICENSE