Provider Demographics
NPI:1366488264
Name:KOEHLER, MELANIE (PCNS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1332
Mailing Address - Country:US
Mailing Address - Phone:401-258-3829
Mailing Address - Fax:
Practice Address - Street 1:1950 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6639
Practice Address - Country:US
Practice Address - Phone:401-258-3829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00016163WP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30031-7OtherBLUE CROSS & BLUE SHIELD
RIMK41385Medicaid
RI409219OtherCOORDINATED HEALTH PLANS
RI007009201OtherRAILROAD MEDICARE
RI05-0468084OtherUNITED HEALTH PLANS
RI409219OtherCOORDINATED HEALTH PLANS