Healthcare Provider Details

I. General information

NPI: 1003331893
Provider Name (Legal Business Name): MELISSA JEAN VINSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 JACKSON AVE W STE 101
OXFORD MS
38655-5624
US

IV. Provider business mailing address

115 APPLE BLOSSOM DR
SALTILLO MS
38866-8730
US

V. Phone/Fax

Practice location:
  • Phone: 662-404-7177
  • Fax: 662-796-3839
Mailing address:
  • Phone: 662-871-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR518921
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: