Melissa Ann Etchison, N.P,

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71004130A Issued in IN

Practice address

806 Jackson St
Columbus, IN 47201

Phone

(812) 748-3412

Fax

(812) 748-3413

NPI assigned

Sep 10, 2012

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Premise Health of North Carolina Medical PC

  • Multi-Specialty Clinic/Center
  • Raleigh, NC
  • NPI 1427575869
  Medicare reassignment NPD
• Premise Health of North Carolina Medical PC

  • Multi-Specialty Clinic/Center
  • Raleigh, NC
  • NPI 1790202133
  NPD

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1144579848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 JACKSON ST",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472016264",
            "telephone_number": "812-748-3412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 JACKSON ST",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "47201",
            "telephone_number": "812-748-3412",
            "fax_number": "812-748-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETCHISON",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "N.P,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004130A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201092460",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000001079109",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P01212103",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Lauren Ertel, PT, DPT
• Estes Neuropsychology
• Estes Neuropsychology, LLC
• Bradley Wayne Estes, PSY.D.
• Heather Estes
• Amberlea Eubanks, RBT
• Evans Psychological and Counseling Services, LLC
• Karl Evans, PHD
• Eventus Wholehealth Midwest Inc
• Alexis Everitt

• Family Nurse Practitioner in Columbus, IN
• Providers in Columbus, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.