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General NPI Number Information
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NPI Number | 1003331893
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Entity Type | Individual
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Provider Name | MELISSA JEAN VINSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 474 W BANKHEAD ST
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City | NEW ALBANY
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State | MS
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Zip | 38652
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Country | US
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Telephone | 662-534-7777
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Fax | 662-534-7777
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Provider Business Mailing Address
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Address Line | 607 E WIYGUL ST
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City | FULTON
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State | MS
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Zip | 38843-8996
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Country | US
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Telephone | 662-871-8584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R518921
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License Number State | MS
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