Provider Demographics
NPI:1184197568
Name:SOPER, MELANIE R (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:SOPER
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:2330 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6411
Practice Address - Country:US
Practice Address - Phone:765-455-8822
Practice Address - Fax:765-865-3935
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28251764A163W00000X
WI222244-30163W00000X
MI4704226990163W00000X
IN71009982A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28251764AOtherSTATE OF INDIANA
MI4704226990OtherSTATE OF MICHIGAN
WI222244-30OtherSTATE OF WISCONSIN