Healthcare Provider Details

I. General information

NPI: 1982914065
Provider Name (Legal Business Name): MELISSA C ROSS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E GORE AVE
GAINESBORO TN
38562-9367
US

IV. Provider business mailing address

225 N WILLOW AVE STE 3
COOKEVILLE TN
38501-2335
US

V. Phone/Fax

Practice location:
  • Phone: 931-268-6899
  • Fax:
Mailing address:
  • Phone: 931-528-8899
  • Fax: 931-520-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN15173
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013214
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: