Provider Demographics
NPI:1942257266
Name:MEAD, MELANIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6465 S YALE AVE STE 815
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7820
Practice Address - Country:US
Practice Address - Phone:918-502-4848
Practice Address - Fax:918-502-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46960363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113330AMedicaid
OK100113330AMedicaid
249425708Medicare ID - Type Unspecified