Provider Demographics
NPI:1811200959
Name:HALL, MELISSA A (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E MATTHEWS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3101
Mailing Address - Country:US
Mailing Address - Phone:870-972-0411
Mailing Address - Fax:870-886-5632
Practice Address - Street 1:505 E MATTHEWS AVE STE 103
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3101
Practice Address - Country:US
Practice Address - Phone:870-972-0411
Practice Address - Fax:870-933-8011
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187695758Medicaid