Provider Demographics
NPI:1205078144
Name:QUALLS, MELISSA CATHERINE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:QUALLS
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 1:200 MCAULEY CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6312
Mailing Address - Country:US
Mailing Address - Phone:501-623-4485
Mailing Address - Fax:501-623-4480
Practice Address - Street 1:200 MCAULEY CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6312
Practice Address - Country:US
Practice Address - Phone:501-623-4485
Practice Address - Fax:501-623-4480
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03224ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177753758Medicaid