Basic Information
| Provider Information | |||||||||
| NPI: | 1124469887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALUMBAUGH | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 S 2ND ST | ||||||||
| Address2: | PO BOX 497 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720062309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8703473492 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 N EDMONDS AVE | ||||||||
| Address2: | |||||||||
| City: | MC CRORY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721018279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707315411 | ||||||||
| FaxNumber: | 8707315431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 10/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A003911 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 199097758 | 05 | AR | MEDICAID |