Provider Demographics
NPI:1740312594
Name:BATISTA, MELODY FARRELL (APRN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:FARRELL
Last Name:BATISTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-1963
Mailing Address - Country:US
Mailing Address - Phone:978-386-6889
Mailing Address - Fax:
Practice Address - Street 1:486 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3011
Practice Address - Country:US
Practice Address - Phone:978-630-3225
Practice Address - Fax:978-630-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132679363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857151Medicaid
MAPN0876OtherBCBS
MA019974OtherMBHP
MA986633OtherNETWORK HEALTH
MANS0476Medicare ID - Type UnspecifiedMEDICARE NUMBER