Provider Demographics
NPI:1699850644
Name:JINKS, MELISSA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JINKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-431-8234
Mailing Address - Fax:707-431-1427
Practice Address - Street 1:1381 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3314
Practice Address - Country:US
Practice Address - Phone:707-431-8234
Practice Address - Fax:707-431-1427
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007645363L00000X
CA15062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9652777Medicaid
WA0218999OtherL&I
WA8864983Medicare PIN
WA9652777Medicaid