MRS. KIMBERLY ANN MELLICK (NPI# 1073897930) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073897930 |
| Entity Type | Individual |
| Full Name | MRS. KIMBERLY ANN MELLICK |
| Credential | MSN, FNP-BC |
| Practice Address |
1415 S Hwy 89 Jackson WY 83001-8515 |
| Mailing Address |
Po Box 428 Jackson WY 83001-0428 |
| Practice Telephone | 3077398999 |
| Practice Fax Number | 3077399222 |
| Mailing Telephone | 3077398999 |
| Mailing Fax Number | 3077399222 |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2015-09-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
23963 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 121882400 | 05 |
| Street Address |
1415 S HWY 89 |
| City | JACKSON |
| State | WY |
| Zip Code | 83001-8515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336169036 | James R Little Jr. | Family Medicine | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2006-07-19 |
| 1093161572 | Lauren E Furtney | Social Worker | 1415 S Hwy 89, Jackson, WY 83001 | 2016-05-13 |
| 1780011551 | Lindsay M Long | Social Worker | 1415 S Hwy 89, Jackson, WY 83001 | 2013-10-10 |
| 1942648365 | Cecelia Tramburg | Nurse Practitioner | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2013-06-07 |
| 1851661284 | Layne Ellen Lash | Nurse Practitioner | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2012-01-02 |
| 1790009454 | Berit L Amundson | Family Medicine | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2010-03-23 |
| 1134307911 | Kevin Sanville | Family Medicine | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2008-02-05 |
| 1194890590 | Jennifer J Fritch | Emergency Medicine | 1415 S Hwy 89, Jackson, WY 83001-8515 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861006108 | Anne Kathleen Milburn | Physical Therapist | 3620 S Park Drive, Jackson, WY 83001 | 2020-09-03 |
| 1568009637 | Katherine Pringle Ford | Case Manager/Care Coordinator | 2065 E. Limber Pine Road, Jackson, WY 83001 | 2019-12-07 |
| 1043878408 | Cossette Burnham | Physical Therapist | Four Pines Physical Therapy, 1090 S Hwy 89, Jackson, WY 83001 | 2019-05-31 |
| 1982169371 | Cynthia Buck Huyffer | Social Worker | 755a Cache Creek Drive, Jackson, WY 83001 | 2019-02-10 |
| 1093281594 | Lara Cilo | Speech-Language Pathologist | 1300 W. Valley Springs Road, Jackson, WY 83001 | 2018-10-23 |
| 1740776202 | Teton Oral and Maxillofacial Surgery | Dentist | 1160 Alpine Ln Ste 1d, Jackson, WY 83001 | 2018-07-09 |
| 1437642055 | Anna Yanchek | Physical Therapist | 1090 Us- 89, Jackson Hole, WY 83001 | 2018-06-08 |
| 1891200762 | Tyler Ross Wright | Chiropractor | 1325 Us-89, Suite 108, Jackson, WY 83001 | 2017-12-13 |
| 1073027280 | Root To Rise Counseling and Consulting, Pllc | Social Worker | 2033 Dandelion Court, Jackson, WY 83001 | 2017-11-27 |
| 1962923912 | Piper Worthington | Social Worker | 1910 High School Rd, Jackson, WY 83001 | 2017-06-29 |
| Find all providers in zip 83001 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on MRS. KIMBERLY ANN MELLICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.