Provider Demographics
NPI:1972197622
Name:VAN ALLEN, MELODY (NP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:VAN ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 CAYUCOS ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2672
Mailing Address - Country:US
Mailing Address - Phone:559-589-4432
Mailing Address - Fax:
Practice Address - Street 1:1000 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1850
Practice Address - Country:US
Practice Address - Phone:559-386-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily