Provider Demographics
NPI:1467760884
Name:TILLMAN-BERNARD, MELISSA LYNETTE (CRNA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNETTE
Last Name:TILLMAN-BERNARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNETTE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4011 SW 29TH ST # 185
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2218
Mailing Address - Country:US
Mailing Address - Phone:785-213-0470
Mailing Address - Fax:
Practice Address - Street 1:4011 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2218
Practice Address - Country:US
Practice Address - Phone:785-213-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2958412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002679200Medicaid
FLG00JDOtherBCBC