Provider Demographics
NPI:1124469887
Name:ALUMBAUGH, MELISSA L (APN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:ALUMBAUGH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 S 2ND ST
Mailing Address - Street 2:PO BOX 497
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2309
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:801 N EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8279
Practice Address - Country:US
Practice Address - Phone:870-731-5411
Practice Address - Fax:870-731-5431
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA003911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199097758Medicaid
AR301220YJG2Medicare PIN
AR57297Medicare PIN