Provider Demographics
NPI:1255345278
Name:COURTNEY, MELISSA H (CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:H
Last Name:COURTNEY
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 E STATE ROAD 62
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-7328
Mailing Address - Country:US
Mailing Address - Phone:812-801-0856
Mailing Address - Fax:812-801-0770
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0856
Practice Address - Fax:812-801-0769
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9437099363L00000X
FLARNP9437099367A00000X
KY3004413367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100139980Medicaid
IN300096281Medicaid