Healthcare Provider Details

I. General information

NPI: 1942928999
Provider Name (Legal Business Name): MELANIE NELSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE BARNES

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S FRONTAGE RD #106
VICKSBURG MS
39180
US

IV. Provider business mailing address

PO BOX 1089
HAMMOND LA
70404-1089
US

V. Phone/Fax

Practice location:
  • Phone: 601-654-7070
  • Fax: 601-636-6233
Mailing address:
  • Phone: 985-892-7070
  • Fax: 985-892-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11210657
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: