Individual provider Active NPI

Melissa Ann Hallum, APRN-CNP

  • Family Nurse Practitioner
  • Tishomingo, OK
National Provider Identifier
1760924153
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0092696 Issued in OK
Practice address
610 E 24TH St
Tishomingo, OK 73460-3245
Phone
(580) 371-2343
Fax
(580) 371-3614
NPI assigned
Nov 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1068494 TX
Family Nurse Practitioner 363LF0000X R0092696 OK Primary

Addresses

Primary practice location

610 E 24TH St
Tishomingo, OK 73460-3245

Mailing address

610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 371-2343

Other identifiers 1

IdentifierTypeStateIssuer
200682930AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170109002633 OK Practitioner - Nurse Practitioner 5193006005 Reassigns benefits to 2 organizations
I20220524001216 TX Practitioner - Nurse Practitioner 5193006005 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1020 N Commerce St
Mercy Clinic Primary Care Commerce
Ardmore, OK 73401-3920
Phone (580) 223-5311

Hospital & facility affiliations

  • Ideal Home Care, L.P. Home health agency, Ardmore, OK, CCN 377678
  • Elara Caring Xxiii Home health agency, Ada, OK, CCN 377568
  • Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0092696OKMDFamily Nurse Practitioner
1068494TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
QV Urgent Care TX PLLC CurrentSince May 16, 2022 Accepting new patients
Mercy Clinic Oklahoma Communities CurrentSince Mar 25, 2024 Accepting new patients
QV Urgent Care TX PLLC CurrentSince May 16, 2022 Accepting new patients
Minuteclinic Diagnostic of Oklahoma LLC Family CurrentSince Jul 14, 2022 Accepting new patients
Minuteclinic Telehealth Services of Texas Association Family CurrentSince Oct 11, 2022 Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Ardmore, Inc. Past Accepting new patients

Locations

1020 N Commerce St
Ardmore, OK 73401
Phone (580) 223-5311

1040 SW 19th St
Moore, OK 73160
Phone (405) 794-3001

2100 SW 119th St
Oklahoma City, OK 73170
Phone (405) 691-1041

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

1600 US Highway 79 S
Henderson, TX 75654
Phone (903) 657-9571

1855 Gattis School Rd
Round Rock, TX 78664
Phone (512) 238-6268

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1760924153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E 24TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603245",
            "telephone_number": "580-371-2343",
            "fax_number": "580-371-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E 24TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603245",
            "telephone_number": "580-371-2343",
            "fax_number": "580-371-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLUM",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1068494",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0092696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200682930A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.