Healthcare Provider Details

I. General information

NPI: 1376609990
Provider Name (Legal Business Name): MELANIE PITTS COKER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 750
JACKSON MS
39216-4608
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4970
  • Fax:
Mailing address:
  • Phone: 601-200-4970
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number858106
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: