MELISSA L MORENO (NPI# 1114030681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114030681 |
| Entity Type | Individual |
| Full Name | MELISSA L MORENO |
| Credential | PA |
| Practice Address |
11050 Mount Belvedere Blvd Usa Meddac/credentials Fort Drum NY 13602-5438 |
| Mailing Address |
11050 Mt Belvedere Blvd Usa Meddac Attn: Credentials Fort Drum NY 13602-5004 |
| Practice Telephone | 3157724025 |
| Practice Fax Number | 3157729498 |
| Mailing Telephone | 3157724025 |
| Mailing Fax Number | 3157729498 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902120215 | Melissa Moreno | Counselor | 400 Stony Brook Ct Ste 1, Newburgh, NY 12550-6522 | 2010-03-16 |
| 1639630130 | Melissa Olivia Moreno | Behavior Technician | 17595 Almahurst St Ste 100a, City of Industry, CA 91748-1792 | 2019-03-27 |
| 1255896122 | Melissa Ann Moreno | Registered Nurse | 104 Circle Dr, Hubbard, TX 76648-2049 | 2019-02-05 |
| 1336632371 | Melissa Moreno | Counselor | 5284 Adolfo Rd Ste 100, Camarillo, CA 93012-6790 | 2018-06-13 |
| 1093231797 | Melissa Rene Moreno | Physical Medicine & Rehabilitation | 21 Spurs Ln Ste 300, San Antonio, TX 78240-1679 | 2017-08-15 |
| 1730557984 | Melissa Moreno | Social Worker | 7550 Futures Dr, Suites104-105, Orlando, FL 32819-9095 | 2015-09-04 |
| 1811125495 | Melissa Ann Moreno | Nurse Anesthetist, Certified Registered | 1000 Carondelet Dr, Kansas City, MO 64114-4673 | 2009-06-23 |
| 1528082187 | Melissa W Moreno I | Nurse Practitioner | 25 Hemlock Dr, Congers, NY 10920-1401 | 2006-07-27 |
| Street Address |
11050 MOUNT BELVEDERE BLVD USA MEDDAC/CREDENTIALS |
| City | FORT DRUM |
| State | NY |
| Zip Code | 13602-5438 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760471932 | Randall Alan Bischoff | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2005-10-19 |
| 1619582657 | Tarah Schmidt | Student in an Organized Health Care Education/Training Program | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2020-09-15 |
| 1538778832 | Daniel L Dettman | Physical Therapist | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2020-07-23 |
| 1942836978 | Christie Hurst | Licensed Practical Nurse | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2020-03-21 |
| 1679033112 | Taylor Nichole Singer | Psychologist | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2019-03-21 |
| 1134692361 | Drew Curtis Evans | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2019-01-10 |
| 1457834814 | Timothy Karnuth | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2018-09-12 |
| 1598248262 | Oscar Alfredo Garzon | Student in an Organized Health Care Education/Training Program | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2018-09-10 |
| 1912484684 | Jacob Papenfuss | Physical Therapist | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2018-07-25 |
| 1285124644 | Marjorie A Evans | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2018-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235697590 | Joshua Lee Hickman | Physician Assistant | Bldg P10506 Euphrates River Valley Rd, Fort Drum, NY 13602 | 2019-03-06 |
| 1447721345 | Lisa Marie Lewis | Social Worker | 11044 Mount Belvedere Blvd, Fort Drum, NY 13602 | 2018-12-17 |
| 1720555253 | Elizabeth M Hover | Social Worker | P11050 Mt Belvedere Blvd, Fort Drum, NY 13602 | 2018-11-02 |
| 1376037424 | Phillip Dakotah Mitchell | Physician Assistant | 10020 Euphrates River Valley Road, Fort Drum, NY 13602 | 2018-06-20 |
| 1063902666 | Guthrie Ahc | Clinic/Center | P19914 M3r Tampa, Fort Drum, NY 13602 | 2018-05-18 |
| 1255846879 | Morgan Elizabeth Callari | Dental Hygienist | 10205 S Riva Ridge Loop, Fort Drum, NY 13602 | 2017-12-05 |
| 1609389097 | John Charles Bockmann | Physician Assistant | Connor Troop Medical Clinic, 10506 Euphrates River Valley Rd, Fort Drum, NY 13602 | 2017-11-08 |
| 1902318207 | Nicholas Andrew Jones | Military Health Care Provider | 10506 S. Riva Ridge, Fort Drum, NY 13602 | 2017-10-26 |
| 1508389198 | Richard Scott Christiansen | Physical Therapist | 10330 S Riva Ridge Loop, Fort Drum, NY 13602 | 2017-07-25 |
| 1811418098 | Emer B Bajuelos | Dentist | Ft Drum W07uaa 10590, Ft Drum, Apo, AP 13602 | 2017-06-28 |
| Find all providers in zip 13602 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710205463 | Joseph Newton Gomez | Physician Assistant | Hhc 2-10 Attack Aviation, 10th Aviation Brigade, Consolidated Aviation Aid Station Building 20355, Fort Drum, NY 13602 | 2010-05-05 |
| 1740738764 | Daniel Gebhardt | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2016-09-19 |
| 1295024669 | Patrick L. Mccurdy | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2011-04-06 |
| 1487880803 | Thomas Zajac II | Physician Assistant | 11050 Mount Belvedere Blvd, Usa Meddac/ Attn: Credentials, Fort Drum, NY 13602-5438 | 2009-06-01 |
| 1356576847 | Dustin Thomas Overholt | Physician Assistant | 11050 Mount Belvedere Blvd, Usa Meddac/credentials, Fort Drum, NY 13602-5438 | 2009-05-27 |
| 1407027071 | Patrick Lang Barker | Physician Assistant | 11050 Mount Belvedere Blvd, Usa Meddac/credentials, Fort Drum, NY 13602-5438 | 2008-03-21 |
| 1881672350 | Tanya Monique Perez | Physician Assistant | 11050 Mount Belvedere Blvd, Usa Meddac/credentials, Fort Drum, NY 13602-5438 | 2006-01-05 |
| 1821076324 | Gregory John Pataky | Physician Assistant | 11050 Mt Belvedere Blvd, Usa Meddac Attn: Credentials, Fort Drum, NY 13602-5004 | 2006-01-04 |
| 1902883564 | Jeanne Yeagle | Physician Assistant | 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438 | 2005-12-27 |
| 1104803964 | George Joseph Devita | Physician Assistant | 11050 Mount Belvedere Blvd, Usa Meddac Attn: Credentials, Fort Drum, NY 13602-5438 | 2005-12-22 |
| Find all providers in FORT DRUM | ||||
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| 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.