Provider Demographics
NPI:1801339163
Name:ANDRADE, MELISSA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LILAC DR., STE. 230
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-509-2918
Mailing Address - Fax:405-987-1010
Practice Address - Street 1:301 LILAC DR., STE. 230
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-509-2918
Practice Address - Fax:405-987-1010
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily