Healthcare Provider Details

I. General information

NPI: 1306012026
Provider Name (Legal Business Name): MELODY HARRISON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SHIRLEY DR
WINCHESTER TN
37398-2256
US

IV. Provider business mailing address

PO BOX 700
SEWANEE TN
37375-0700
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-0470
  • Fax: 931-962-0450
Mailing address:
  • Phone: 931-598-5648
  • Fax: 931-598-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAPN0000005673
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN5673
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: