Provider Demographics
NPI:1083938476
Name:OWENS, MELISSA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HAINES AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-0615
Mailing Address - Country:US
Mailing Address - Phone:605-791-7728
Mailing Address - Fax:308-633-1327
Practice Address - Street 1:1730 HAINES AVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0615
Practice Address - Country:US
Practice Address - Phone:605-791-7728
Practice Address - Fax:308-633-1327
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2165363LF0000X
MSR892549363LF0000X
NE114676363LF0000X
WY52066363LF0000X
SDCP002623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04652841Medicaid
MS04652841Medicaid