Provider Demographics
NPI:1952555120
Name:KOON, MELISSA G (ANP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:KOON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6313
Mailing Address - Country:US
Mailing Address - Phone:520-544-9890
Mailing Address - Fax:520-544-9894
Practice Address - Street 1:7740 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6313
Practice Address - Country:US
Practice Address - Phone:520-544-9890
Practice Address - Fax:520-544-9894
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner