Provider Demographics
NPI:1922189257
Name:PALKO, MELISSA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PALKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:MID-ATLANTIC ANESTHESIA CONSULTANTS, LLC
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1167
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN527318L367500000X
WVAPRN61206CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020559Medicaid
WV9333201OtherGROUP MEDICARE
WV0207026000OtherMEDICAID GROUP
WV3810020559Medicaid
WV0207026000OtherMEDICAID GROUP