Melissa Pakkala Hustak, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004312 Issued in MI

Practice address

444 Michigan St NE # Mc288
Grand Rapids, MI 49503-3317

Phone

(616) 267-7469

NPI assigned

Nov 8, 2006

Last updated

Sep 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1063582146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 MICHIGAN ST NE # MC288",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033317",
            "telephone_number": "616-267-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSTAK",
        "first_name": "MELISSA",
        "middle_name": "PAKKALA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Huson
• Rachel Marie Huss, PT, DPT
• Elora Hussain, M.D.
• Syed Adnan Hussain, DO
• Keith T Hustak, PA-C
• Anthony Huston
• Nicolas Paul Hutchens
• Jennifer Beth Hutchings, PH.D, LMFT
• Clementine Marie Hutchins
• Derek Michael Hutchins, MD

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.