Provider Demographics
NPI:1518425727
Name:ETCHISON, MELISSA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:ETCHISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-574-1254
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:2009 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4216
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008826A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily