Provider Demographics
NPI:1003411604
Name:COGDELL, MELISSA ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:COGDELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BRIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7810
Mailing Address - Country:US
Mailing Address - Phone:865-227-8186
Mailing Address - Fax:
Practice Address - Street 1:505 E MATTHEWS AVE STE 303
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3101
Practice Address - Country:US
Practice Address - Phone:870-932-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214344367500000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program