Melissa Plaisted, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

58030 Issued in ID

Practice address

3100 Channing Way
Idaho Falls, ID 83404-7533

Phone

(208) 529-6111

Fax

(208) 529-7021

NPI assigned

Apr 21, 2018

Last updated

May 25, 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 2

Addresses

Other names 1

• Melissa Mickelsen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1524268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1346737608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277381",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-529-6111",
            "fax_number": "208-529-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLAISTED",
        "first_name": "MELISSA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-21",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "58030",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "58030",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MICKELSEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pinnacle Health Systems
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• Susannah Lynn Pipkin, LMSW
• Mary Rachel Pirkle, CNM
• Joshua L Pixton, DNP-PMHNP
• Demetrios Plomaritis, PA-C
• Kathleen Victoria Poduska, LCPC
• Jaron Kirk Polatis
• David Jon Pombo, M.D.
• Paul Anthony Pomeroy II

• Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.