Individual
MELISSA GAYLE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
203 W REDGRAVE DR, MERIDIAN, ID 83646-0011
(986) 200-1006
Mailing address
203 W REDGRAVE DR, MERIDIAN, ID 83646-0011
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1271084
ID
Other
Enumeration date
10/03/2025
Last updated
03/27/2026
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