Provider Demographics
NPI:1548565666
Name:PICKETT, MELISSA ANNE (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LAKE VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-5633
Mailing Address - Country:US
Mailing Address - Phone:573-216-8370
Mailing Address - Fax:
Practice Address - Street 1:2101 CORONA RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2582
Practice Address - Country:US
Practice Address - Phone:573-882-1855
Practice Address - Fax:573-884-4965
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016429364SA2200X
MO120761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily