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Contact Information

KIMBERLY A MELLICK, MSN, FNP-BC
1110 MAPLE WAY
JACKSON, WY83001
 Phone: 307-733-7003
 Fax: 307-734-8477
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for KIMBERLY A MELLICK · (Female)

NPI Number 1073897930
Status Active
Credentials MSN, FNP-BC
Entity Individual
Enumeration date 10/10/2011
Last updated 07/24/2025 - About 11 months ago
Sole proprietor 1 No
Identifiers
  • WY License # 1137
  • WY Medicaid 121882400
Hospital affiliation(s)
  • ST JOHNS MEDICAL CENTER - (Acute Care)
    625 EAST BROADWAY
    JACKSON, WY 83001
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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