Individual
MRS. KIMBERLY ANN MELLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC
Contact information
Practice address
1110 MAPLE WAY, JACKSON, WY 83001
(307) 733-7003
(307) 734-8477
Mailing address
PO BOX 10738, JACKSON, WY 83002-0738
(307) 733-7003
(307) 734-8477
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1137
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121882400
—
WY
Enumeration date
10/10/2011
Last updated
07/24/2025
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