Healthcare Provider Details

I. General information

NPI: 1043676422
Provider Name (Legal Business Name): MELISSA MONROE MSN, BSN, APRN, AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E COLLEGE ST STE 3
PULASKI TN
38478-4564
US

IV. Provider business mailing address

600 S JAMES M CAMPBELL BLVD
COLUMBIA TN
38401-4334
US

V. Phone/Fax

Practice location:
  • Phone: 931-347-9125
  • Fax: 931-347-9127
Mailing address:
  • Phone: 866-668-2188
  • Fax: 888-794-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20881
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20881
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: