Healthcare Provider Details

I. General information

NPI: 1720749799
Provider Name (Legal Business Name): MELANEE SEYMOUR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 LORRAINE RD STE 101
GULFPORT MS
39503-5053
US

IV. Provider business mailing address

8927 LORRAINE RD STE 101
GULFPORT MS
39503-5053
US

V. Phone/Fax

Practice location:
  • Phone: 720-254-8634
  • Fax:
Mailing address:
  • Phone: 720-254-8634
  • Fax: 228-203-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number330061
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: