Provider Demographics
NPI:1558657007
Name:RICHEY, MELISSA S (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:RICHEY
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:PO BOX 26568
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6568
Mailing Address - Country:US
Mailing Address - Phone:928-778-1251
Mailing Address - Fax:928-778-7834
Practice Address - Street 1:3251 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1222
Practice Address - Country:US
Practice Address - Phone:928-772-2582
Practice Address - Fax:928-772-2383
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990127363LF0000X
AZAP5757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMSL150222COOtherARIZONA STATE BOARD OF NURSING
COF0511198OtherAANP