Provider Demographics
NPI:1760924153
Name:HALLUM, MELISSA ANN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HALLUM
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3920
Mailing Address - Country:US
Mailing Address - Phone:580-223-5311
Mailing Address - Fax:580-223-2397
Practice Address - Street 1:1020 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3920
Practice Address - Country:US
Practice Address - Phone:580-223-5311
Practice Address - Fax:580-223-2397
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068494363LF0000X
OKR0092696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily