Provider Demographics
NPI:1891508479
Name:ABBOTT, MELISSA (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10312 S 194TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-3515
Mailing Address - Country:US
Mailing Address - Phone:918-500-8883
Mailing Address - Fax:
Practice Address - Street 1:10312 S 194TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-3515
Practice Address - Country:US
Practice Address - Phone:918-500-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0086219163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice