Individual provider Active NPI

Melanie Marie Klockner, CPNP-PC

  • Pediatric Nurse Practitioner
  • Austintown, OH
National Provider Identifier
1003330499
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
20172682 Issued in OH
Practice address
5480 Norquest Blvd
Austintown, OH 44515-1820
Phone
(330) 779-0529
NPI assigned
Jul 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 20172682 OH Primary

Addresses

Primary practice location

5480 Norquest Blvd
Austintown, OH 44515-1820

Mailing address

1 Perkins SQ
Akron, OH 44308-1063
Phone (330) 779-0529

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mklockner9795@direct.chmca.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170926001210 OH Practitioner - Nurse Practitioner 3678847969 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
20172682OHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Akron Children'S Hospital Current Accepting new patients
Children'S Hospital Medical Center of Akron CurrentSince Sep 1, 2017 Accepting new patients
Children'S Hospital Medical Center of Akron CurrentSince Sep 1, 2017 Accepting new patients
Children'S Hospital Medical Center of Akron Current Accepting new patients

Locations

2140 13th St SW
Akron, OH 44314

1 Perkins Sq
Akron, OH 44308
Phone (330) 543-8050

5480 Norquest Blvd
Youngstown, OH 44515
Phone (330) 779-0529

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1003330499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-779-0529",
            "fax_number": "330-797-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5480 NORQUEST BLVD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445151820",
            "telephone_number": "330-779-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCKNER",
        "first_name": "MELANIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "20172682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mklockner9795@direct.chmca.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5480 Norquest Blvd",
            "city": "Austintown",
            "state": "OH",
            "country_code": "US",
            "postal_code": "445151820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Austintown, OH

Sources for this page

Verify at the official NPI Registry.