Provider Demographics
NPI:1104188754
Name:FOLEY, MELINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:FOLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:
Practice Address - Street 1:303 S MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2503
Practice Address - Country:US
Practice Address - Phone:260-888-2102
Practice Address - Fax:260-919-3563
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003970A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71003970AOtherST LICENSE