Doctor Name: | MELINDA UPSHUR |
NPI Number: | 1518349950 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | A004430 |
Business Practice Address: | 2918 Louis Sessions St Lake Village, AR - 716536049 |
Business Phone Number: | 8702655343 |
Business Fax Number: | 8702655686 |
Mailing Address: | 2918 Louis Sessions St, LAKE VILLAGE |
State: | AR |
Postal Code: | 716536049 |
Phone Number: | 8702655343 |
Fax Number: | 8702655686 |
NPI Enumeration Date: | 06/22/2015 |
NPI Last Update Date: | 01/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A004430 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |