Individual provider Active NPI

Melissa Holman, CRNP

  • Registered Nurse
  • Dothan, AL
National Provider Identifier
1669567608
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
1-079347 Issued in AL
Practice address
207 Haven Dr
Dothan, AL 36301-2919
Phone
(334) 793-3319
Fax
(334) 793-2291
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-079347 AL Primary

Addresses

Primary practice location

207 Haven Dr
Dothan, AL 36301-2919

Mailing address

207 Haven Dr
Dothan, AL 36301-2919
Phone (334) 793-3319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20100921001378 AL Practitioner - Nurse Practitioner 8022134527 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-079347ALMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Hypertension Nephrology Associates CurrentSince Mar 18, 2003 Accepting new patients

Locations

207 Haven Dr
Dothan, AL 36301
Phone (334) 793-1964

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1669567608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMAN",
        "first_name": "MELISSA",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-079347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.