Provider Demographics
NPI:1588752869
Name:GOODNIGHT, MELANIE E (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:GOODNIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1435 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2723
Mailing Address - Country:US
Mailing Address - Phone:307-675-2650
Mailing Address - Fax:307-675-2651
Practice Address - Street 1:1435 BURTON ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2723
Practice Address - Country:US
Practice Address - Phone:307-675-2650
Practice Address - Fax:307-675-2651
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155558363L00000X
KS1485905121363L00000X
WY27454.1008363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24971Medicare UPIN
WY1942490891Medicaid