Individual
MRS. MELODY ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACAGNP-BC
Contact information
Practice address
222 E PRIMROSE ST STE E, SPRINGFIELD, MO 65807-5233
(417) 553-1080
(888) 472-5145
Mailing address
222 E PRIMROSE ST STE E, SPRINGFIELD, MO 65807-5233
(417) 553-1080
(888) 472-5145
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2020040257
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420118182
—
MO
Enumeration date
09/30/2021
Last updated
01/17/2023
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