Individual
MRS. MELISSA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
3800 S NATIONAL AVE FL 4, SPRINGFIELD, MO 65807-5209
(417) 875-3755
(417) 875-3295
Mailing address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3022
(417) 875-3019
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2002010564
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002010564
STATE LICENSE
MO
Enumeration date
09/20/2006
Last updated
07/24/2012
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