Provider Demographics
NPI:1265044747
Name:CARLSON, MELYSSA (DNP, BSN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MELYSSA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DNP, BSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N 209TH AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-5495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14823 W BELL RD STE 208
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7613
Practice Address - Country:US
Practice Address - Phone:623-225-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259493163WE0003X, 363LP0200X
WARN60945219163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP0200XNursing Service ProvidersRegistered NursePediatrics