Provider Demographics
NPI:1972232593
Name:JUSTICE, MELINDA MARIE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S L ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5242
Mailing Address - Country:US
Mailing Address - Phone:479-522-5050
Mailing Address - Fax:
Practice Address - Street 1:2120 S L ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5242
Practice Address - Country:US
Practice Address - Phone:479-522-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219617363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health