Provider Demographics
NPI:1114454048
Name:DAVIDSON, MELANIE ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:900 E BATTLEFIELD ST STE 124
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5208
Mailing Address - Country:US
Mailing Address - Phone:417-986-1289
Mailing Address - Fax:
Practice Address - Street 1:900 E BATTLEFIELD ST STE 124
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5208
Practice Address - Country:US
Practice Address - Phone:417-986-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily