Provider Demographics
NPI:1215495080
Name:CODY, MELANIE KRISTEN (FNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KRISTEN
Last Name:CODY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KRISTEN
Other - Last Name:HOOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:19875 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5114
Mailing Address - Country:US
Mailing Address - Phone:623-581-8998
Mailing Address - Fax:623-581-6461
Practice Address - Street 1:19875 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5114
Practice Address - Country:US
Practice Address - Phone:623-581-8998
Practice Address - Fax:623-581-6461
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily