Provider Demographics
NPI:1730280611
Name:HUTTON, MELISSA MCALLISTER (MSN, CRNP, ARNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MCALLISTER
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MSN, CRNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6223 WATERMARK DR
Mailing Address - Street 2:APT. 104
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3977
Mailing Address - Country:US
Mailing Address - Phone:240-625-6550
Mailing Address - Fax:
Practice Address - Street 1:6223 WATERMARK DR
Practice Address - Street 2:APT. 104
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3977
Practice Address - Country:US
Practice Address - Phone:240-625-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073583363LA2200X
FLARNP 9381896363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP57975Medicare UPIN