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NPI Code Detail

MEDICARE: MELINA PAIGE JETTON RN

MEDICARE: MELINA PAIGE JETTON 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
1163W00000XRegistered NurseR885340MS

General Provider Information

NPI Number : 1699058669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINA PAIGE JETTON RN
Provider Business Mailing Address
First Line : PO BOX 839
Second Line :
City : CORINTH
State : MS
Zip : 38835-0839
Country : US
Telephone Number : 662-286-9883
Fax Number : 662-286-9836
Provider Business Practice Location Address
First Line : 2664 S HARPER RD
Second Line :
City : CORINTH
State : MS
Zip : 38834-6723
Country : US
Telephone Number : 662-287-4055
Fax Number : 662-287-4114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 09/26/2011

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