Mellick, Kimberly Ann

Mellick, Kimberly Ann is an individual health care provider with primary practice located at 1415 S Hwy 89 , Jackson WY 83001-8515. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Mellick, Kimberly Ann can be contacted via phone (307) 739-8999.

Contact Information

Primary practice address
1415 S Hwy 89 Jackson WY 83001-8515
Fax: (307) 739-9222
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 1137 Wyoming

Profile Details

NPI number 1073897930
LBN Legal business name Mellick, Kimberly Ann
Credentials MSN, FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2011
Last updated Feb 15th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073897930 NPPES
Wyoming MEDICAID 121882400

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