Provider Demographics
NPI:1144638842
Name:BRUEGGEMANN, MELISSA RENEE
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:NAVAS-BRUEGGEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:334 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3464
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-341-7482
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1125425363LF0000X
KY3008843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100312860Medicaid
KYK151591Medicare PIN