Provider Demographics
NPI:1669561411
Name:MELSON, LINDSAY R (APN)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:MELSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-7101
Mailing Address - Country:US
Mailing Address - Phone:501-812-7587
Mailing Address - Fax:501-812-7588
Practice Address - Street 1:9500 KANIS RD
Practice Address - Street 2:HICKINGBOTHAM OUTPAITENT CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6324
Practice Address - Country:US
Practice Address - Phone:501-202-1902
Practice Address - Fax:501-202-1512
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
71-0781138OtherGREAT WEST
710781138028OtherTRICARE
4345098OtherCIGNA
5A116OtherBCBS
710781138028OtherTRICARE
Q74853Medicare UPIN
5A1166884Medicare PIN