Provider Demographics
NPI:1811904568
Name:TOMPKINS, MELISSA L (PA C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:L
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0518
Mailing Address - Country:US
Mailing Address - Phone:402-269-2011
Mailing Address - Fax:402-269-2795
Practice Address - Street 1:2731 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-7880
Practice Address - Country:US
Practice Address - Phone:402-269-2011
Practice Address - Fax:402-269-3369
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37857OtherBCBS OF NEBRASKA
NE092292006Medicare PIN
NE37857OtherBCBS OF NEBRASKA
NE086100005Medicare PIN
NE279610Medicare PIN