Provider Demographics
NPI:1427367804
Name:STATES, MELISSA MEAGAN (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MEAGAN
Last Name:STATES
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4600
Mailing Address - Country:US
Mailing Address - Phone:405-375-5222
Mailing Address - Fax:405-375-5234
Practice Address - Street 1:1610 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4600
Practice Address - Country:US
Practice Address - Phone:405-375-5222
Practice Address - Fax:405-375-5234
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0071397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200318780AMedicaid
OK200318780AMedicaid
OK200318780AMedicaid