Provider Demographics
NPI:1780079004
Name:ANTHONY, MELISSA A (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6920 PARKDALE PL STE 215
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5611
Mailing Address - Country:US
Mailing Address - Phone:317-939-6100
Mailing Address - Fax:317-343-4600
Practice Address - Street 1:6920 PARKDALE PL STE 215
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5611
Practice Address - Country:US
Practice Address - Phone:317-939-6100
Practice Address - Fax:317-343-4600
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005411A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201286510Medicaid