Provider Demographics
NPI:1861656043
Name:DUMAS, MELANIE A
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:A
Last Name:DUMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2545
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2545
Mailing Address - Country:US
Mailing Address - Phone:870-534-7679
Mailing Address - Fax:
Practice Address - Street 1:624 W 23RD AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6304
Practice Address - Country:US
Practice Address - Phone:870-534-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160835783Medicaid