MEDICARE: MELISSA WHEATON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	905239	MS

General Provider Information

NPI Number	:	1629791660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WHEATON FNP-BC

Provider Business Mailing Address
First Line	:	270 TRACE COLONY PARK DR # B
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-8810
Country	:	US
Telephone Number	:	601-236-1800
Fax Number	:	601-258-6668

Provider Business Practice Location Address
First Line	:	270 TRACE COLONY PARK DR # B
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-8810
Country	:	US
Telephone Number	:	601-236-1800
Fax Number	:	601-258-6668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	04/07/2026

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