Basic Information
| Provider Information | |||||||||
| NPI: | 1982167029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELISSA DIRST-ROBERTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 HIGHWAY 62 E STE 10 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726533200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704243181 | ||||||||
| FaxNumber: | 8704243181 | ||||||||
| Practice Location | |||||||||
| Address1: | 860 HIGHWAY 62 E STE 10 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726533200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704243181 | ||||||||
| FaxNumber: | 8704243089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2019 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | DIRST-ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 8704243181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 798944 | 01 | AR | MEDICARE | OTHER | 234235002 | 05 | AR | MEDICAID |