Provider Demographics
NPI:1851589683
Name:PEYTON, MELISSA MARGARET (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:PEYTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARGARET
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3740 UTICA RIDGE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1624
Mailing Address - Country:US
Mailing Address - Phone:563-344-7400
Mailing Address - Fax:563-359-9395
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1657
Practice Address - Country:US
Practice Address - Phone:563-344-7400
Practice Address - Fax:563-359-9395
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003087363A00000X
IA001864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003087OtherILLINOIS LICENSE
IA71333OtherWELLMARK
IA001864OtherLICENSE
IAI21742Medicare PIN
ILK31965Medicare PIN