MEDICARE: BEVERLY KAY MELSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN0000111041	TN

General Provider Information

NPI Number	:	1588791867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY KAY MELSON RN

Provider Business Mailing Address
First Line	:	1112 NASHVILLE HWY
Second Line	:	APT. C-3
City	:	COLUMBIA
State	:	TN
Zip	:	38401-2161
Country	:	US
Telephone Number	:	931-490-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BLYTHEWOOD DR
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4828
Country	:	US
Telephone Number	:	931-388-5757
Fax Number	:	931-381-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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