Provider Demographics
NPI:1043263700
Name:MARKHAM, MELISSA L (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 HWY 441 N
Mailing Address - Street 2:STE F
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972
Mailing Address - Country:US
Mailing Address - Phone:863-763-8000
Mailing Address - Fax:863-763-8212
Practice Address - Street 1:1713 HWY 441 N
Practice Address - Street 2:STE F
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-763-8000
Practice Address - Fax:863-763-8212
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101714207V00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259038700Medicaid
P66600Medicare UPIN
FL259038700Medicaid