Individual
MELISSA N MOORE-COLVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3201 N VAN BUREN ST STE 350, ENID, OK 73703-1814
(580) 366-0844
(580) 297-5197
Mailing address
3201 N VAN BUREN ST STE 350, ENID, OK 73703-1814
(580) 366-0844
(580) 297-5197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1976
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
OK
Enumeration date
01/19/2011
Last updated
11/20/2019
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