Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | A01819 | AR |
NPI | 1013901214 |
---|---|
Provider Name | Mrs. Melissa J Allison |
First Address | Maumelle, AR 72113 |
Second Address | Little Rock, AR 72205-5446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 06/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5Y072 | BCBS (01) | AR |
Q29748 | (02) | AR |