Provider Demographics
NPI:1972988723
Name:KELLER, MELISSA (APN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-3274
Mailing Address - Country:US
Mailing Address - Phone:870-674-6489
Mailing Address - Fax:870-672-6823
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-674-6489
Practice Address - Fax:870-672-6823
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100907002Medicaid
AR201482729Medicaid
AR203673729Medicaid
AR201478729Medicaid
AR201481729Medicaid
AR201477729Medicaid
AR201479729Medicaid
AR043492Medicare Oscar/Certification
AR043480Medicare Oscar/Certification
AR043457Medicare Oscar/Certification
AR201482729Medicaid
AR100907002Medicaid
AR203673729Medicaid
AR043489Medicare Oscar/Certification