Russell, Melody Ann

Russell, Melody Ann is an individual health care provider with primary practice located at 222 E Primrose St Ste E , Springfield MO 65807-5233. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Russell, Melody Ann can be contacted via phone (417) 553-1080.

Contact Information

Primary practice address
222 E Primrose St Ste E Springfield MO 65807-5233
Phone: (417) 553-1080
Fax: (888) 472-5145
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 2020040257 Missouri

Profile Details

NPI number 1114699923
LBN Legal business name Russell, Melody Ann
Credentials ACAGNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2021
Last updated Jan 17th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114699923 NPPES
Missouri MEDICAID 420118182

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