Healthcare Provider Details

I. General information

NPI: 1639556699
Provider Name (Legal Business Name): MELANIE HUTCHISON-GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE NICOLE HUTCHISON

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 NEW COVINGTON PIKE CARDIOVASCULAR SERVICES
MEMPHIS TN
38128-2504
US

IV. Provider business mailing address

5050 POPLAR AVE STE 800
MEMPHIS TN
38157-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-5289
  • Fax: 901-516-5173
Mailing address:
  • Phone: 901-276-2662
  • Fax: 901-274-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number19896
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: