Provider Demographics
NPI:1386317725
Name:MOORE, MELANIE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 POST OAK ST
Mailing Address - Street 2:
Mailing Address - City:CROWDER
Mailing Address - State:OK
Mailing Address - Zip Code:74430
Mailing Address - Country:US
Mailing Address - Phone:918-429-2145
Mailing Address - Fax:
Practice Address - Street 1:340 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6075
Practice Address - Country:US
Practice Address - Phone:918-420-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK223726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily