Healthcare Provider Details

I. General information

NPI: 1932159845
Provider Name (Legal Business Name): MELANIE JOY/MCCOLLUM BODINE RN/CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST BOX 159
CHATTANOOGA TN
37403-2103
US

IV. Provider business mailing address

2301 COVINGTON COVE LN
SIGNAL MOUNTAIN TN
37377-1277
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6170
  • Fax:
Mailing address:
  • Phone: 423-886-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPN0000010881
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: