Melissa Mantooth, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2066467 Issued in AL

Practice address

Building 301 Andrews Ave.
Lyster Army Health Clinic
Fort Rucker, AL 36362-5333

Phone

(334) 255-7930

NPI assigned

Oct 26, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1235501693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BUILDING 301 ANDREWS AVE.",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363625333",
            "telephone_number": "334-255-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING 301 ANDREWS AVE.",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363625333",
            "telephone_number": "334-255-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOOTH",
        "first_name": "MELISSA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AL",
            "license": "2066467",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "P324855",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "HI",
            "license": "LPN16824",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew John Maich, NREMT
• Richard Glade Malish, MD
• Lydia Malloy, AU.D., CCC-SLP
• Bobbie Malone, R.PH.
• Cara Leigh Mann
• Billie Jo Marbrey, LPN
• Elizabeth Ann Marriott, EDIS
• Miriam Marrs, ENT TECHNICIAN
• Jennifer Signe Marsden, M.D.
• Joni P. Martin, LCSW, PIP

• Licensed Practical Nurse in Fort Rucker, AL
• Providers in Fort Rucker, AL by specialty
• Licensed Practical Nurse in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.