# MELLOY CONCIERGE AND AESTHETICS MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184311342
- **Authorized official:** JONALEE FORTINER (OFFICE MANAGER)
- **Authorized official phone:** (479) 435-4207

## Contact information

- **Practice address:** 200 S 20TH ST STE C, ROGERS, AR 72758-1100
- **Practice address phone:** (479) 278-7010
- **Practice address fax:** (479) 974-2009
- **Mailing address:** PO BOX 3013, BELLA VISTA, AR 72715-0013
- **Mailing address phone:** (479) 278-7010
- **Mailing address fax:** (479) 974-2009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2023
- **Last updated:** 06/10/2026