Provider Demographics
NPI:1467594770
Name:HILL, MELINDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2206
Mailing Address - Country:US
Mailing Address - Phone:417-820-8099
Mailing Address - Fax:
Practice Address - Street 1:2055 S FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2206
Practice Address - Country:US
Practice Address - Phone:417-820-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425828007Medicaid
AR82370OtherARK BLUE SHIELD
MO155891OtherMO BLUE SHIELD
MO1467594770Medicaid
AR161390758Medicaid
OK200618750AMedicaid
KS200879520BMedicaid
MO000081212Medicare PIN
MO000081208Medicare PIN
MO155891OtherMO BLUE SHIELD
P53198Medicare UPIN
MO425828007Medicaid