Melissa Emily Ballou, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN63724 Issued in RI

Practice address

4705 Old Post Rd Unit a
Charlestown, RI 02813-1842

Phone

(401) 364-7705

Fax

(401) 364-1982

NPI assigned

Apr 13, 2022

Last updated

Feb 12, 2025By 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

Other names 1

• Melissa Emily Mactavish Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1548902141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 OLD POST RD UNIT A",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131842",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOU",
        "first_name": "MELISSA",
        "middle_name": "EMILY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "RI",
            "license": "RN63724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MACTAVISH",
            "middle_name": "EMILY",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Nurse in Charlestown, RI
• Providers in Charlestown, RI by specialty
• Registered Nurse in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; 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.