Provider Demographics
NPI:1528627676
Name:LARYEA, MELINDA YVETTE (APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:YVETTE
Last Name:LARYEA
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTGLEN CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4145
Mailing Address - Country:US
Mailing Address - Phone:501-240-1845
Mailing Address - Fax:
Practice Address - Street 1:110 W COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5848
Practice Address - Country:US
Practice Address - Phone:501-821-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily