Healthcare Provider Details

I. General information

NPI: 1518920107
Provider Name (Legal Business Name): MELISSA D HICKMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 MACKEY BRANCH DR
CHATTANOOGA TN
37421-3225
US

IV. Provider business mailing address

910 BLACKFORD STREET
CHATTANOOGA TN
37403
US

V. Phone/Fax

Practice location:
  • Phone: 423-443-3336
  • Fax: 423-464-7510
Mailing address:
  • Phone: 423-778-5255
  • Fax: 423-778-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number10883
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10883
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: