Individual provider Active NPI

Melissa Anne Micheletti, BSN, RN, CLC

  • Lactation Consultant (Registered Nurse)
  • Clovis, NM
National Provider Identifier
1982206512
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X
License
RN-75172 Issued in NM
Practice address
318 Credible Loop
Clovis, NM 88101-8864
Phone
(469) 992-5871
NPI assigned
Nov 9, 2020
Reactivated
Nov 24, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Registered Nurse) 163WL0100X RN-75172 NM Primary

Addresses

Primary practice location

318 Credible Loop
Clovis, NM 88101-8864

Mailing address

318 Credible Loop
Clovis, NM 88101-8864
Phone (469) 992-5871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN-75172NMMDLactation Consultant (Registered Nurse)

Practice roles

OrganizationSpecialtyStatusNew patients
Nursing Mama LLC CurrentSince Nov 22, 2020 Accepting new patients

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": "1604880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1982206512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 CREDIBLE LOOP",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018864",
            "telephone_number": "469-992-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 CREDIBLE LOOP",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018864",
            "telephone_number": "469-992-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHELETTI",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "BSN, RN, CLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "deactivation_date": "2020-11-10",
        "reactivation_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NM",
            "license": "RN-75172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; 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.