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General NPI Number Information
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NPI Number | 1629614128
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Entity Type | Individual
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Provider Name | MELISSA ANN WISNER NP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 54 SGT PRENTISS DR
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City | NATCHEZ
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State | MS
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Zip | 39120-4726
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Country | US
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Telephone | 601-490-7070
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Fax | 601-442-3199
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | HAMMOND
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State | LA
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Zip | 70404-1089
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Country | US
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Telephone | 985-892-7070
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Fax | 985-892-7017
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 903665
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License Number State | MS
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