Provider Demographics
NPI:1356827802
Name:MELVIN, KRISTIE A (ARNP, DNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:MELVIN
Suffix:
Gender:F
Credentials:ARNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-9401
Mailing Address - Country:US
Mailing Address - Phone:608-339-5250
Mailing Address - Fax:
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5099
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12110-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily