Provider Demographics
NPI:1669097119
Name:BECKHAM, MELANIE NICOLE (RN, PMHNP)
Entity type:Individual
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First Name:MELANIE
Middle Name:NICOLE
Last Name:BECKHAM
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Gender:F
Credentials:RN, PMHNP
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Mailing Address - Street 1:18614 JACKSON STREET
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668
Mailing Address - Country:US
Mailing Address - Phone:417-745-2121
Mailing Address - Fax:417-745-0056
Practice Address - Street 1:1100 SOUTH SPRINGFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-7272
Practice Address - Fax:417-326-2193
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
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Provider Licenses
StateLicense IDTaxonomies
MO2020012746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health