Healthcare Provider Details

I. General information

NPI: 1609844562
Provider Name (Legal Business Name): MELISSA MARTIN BYRD CPCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MELISSA LYNN MARTIN

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19283 HIGHWAY 59
SUMMERDALE AL
36580-3005
US

IV. Provider business mailing address

19283 HIGHWAY 59
SUMMERDALE AL
36580-3005
US

V. Phone/Fax

Practice location:
  • Phone: 251-523-5437
  • Fax: 866-628-7517
Mailing address:
  • Phone: 251-523-5437
  • Fax: 866-628-7517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9200085
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-081366
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: