Individual
MELISSA ANN ETCHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P,
Contact information
Practice address
806 JACKSON ST, COLUMBUS, IN 47201
(812) 748-3412
(812) 748-3413
Mailing address
806 JACKSON ST, COLUMBUS, IN 47201-6264
(812) 748-3412
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004130A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001079109
ANTHEM
IN
05
—
201092460
—
IN
01
—
P01212103
RR MEDICARE PTAN
IN
Enumeration date
09/10/2012
Last updated
08/02/2018
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