Provider Demographics
NPI:1306919857
Name:HARRIS, MELODEE LEE (APN)
Entity type:Individual
Prefix:
First Name:MELODEE
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:MELODEE
Other - Middle Name:LEE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:629 JACK STEPHENS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5525
Practice Address - Country:US
Practice Address - Phone:501-526-5798
Practice Address - Fax:501-686-6234
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01739ANP163WG0600X
ARA001739363LG0600X
ARR70398163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y783Medicare ID - Type UnspecifiedPROVIDER BILLING NUMBER