Provider Demographics
NPI:1215223151
Name:FUQUA, MELINDA D (NP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:D
Last Name:FUQUA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:D
Other - Last Name:GRABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-481-8476
Mailing Address - Fax:812-481-8497
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1019
Practice Address - Country:US
Practice Address - Phone:812-242-3390
Practice Address - Fax:812-242-3384
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003678A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily