Healthcare Provider Details

I. General information

NPI: 1659511244
Provider Name (Legal Business Name): PAMELA MELVIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WINCHESTER RD SOUTHEAST MENTAL HEALTH CENTER
MEMPHIS TN
38118-6045
US

IV. Provider business mailing address

6685 WILLOW BROOK ST
MILLINGTON TN
38053-7943
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-1420
  • Fax: 901-369-1433
Mailing address:
  • Phone: 901-873-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number98282
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number98282
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: