Provider Demographics
NPI:1669431888
Name:GRIFFIN, MELISSA A (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:657-827-7840
Mailing Address - Fax:765-827-7841
Practice Address - Street 1:1941 VIRGINIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2881
Practice Address - Country:US
Practice Address - Phone:765-827-7840
Practice Address - Fax:765-827-7841
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001884A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506160Medicaid
000000682482OtherANTHEM
OH0067504Medicaid
000000682482OtherANTHEM