Provider Demographics
NPI:1821075243
Name:MCCORD, MELIA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELIA
Middle Name:NICOLE
Last Name:MCCORD
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:801 E ORANGE ST
Practice Address - Street 2:HOOPESTON COMMUNITY MEMORIAL HOSPITAL DBA CHARLOTTE ANN
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1802
Practice Address - Country:US
Practice Address - Phone:217-283-5644
Practice Address - Fax:217-283-7432
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-01-22
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Provider Licenses
StateLicense IDTaxonomies
IL085-002550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002550OtherSTATE LICENSE NUMBER
IL108919OtherHEALTH ALLIANCE
IL108919OtherHEALTH ALLIANCE
IL108919OtherHEALTH ALLIANCE