Provider Demographics
NPI:1376153494
Name:BROUGHTON, MELISSA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10276-0058
Mailing Address - Country:US
Mailing Address - Phone:646-820-7378
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 58
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10276-0058
Practice Address - Country:US
Practice Address - Phone:646-820-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037817363L00000X, 363LP0808X
OH0038485363L00000X, 363LP0808X
WAAP61673408363L00000X, 363LP0808X
TN37871363LP0808X
MI4704420854363LP0808X
VA0001332977363LP0808X
MARN2321864363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner