Provider Demographics
NPI:1194075416
Name:NOLAN, MELISSA RICHARDSON (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RICHARDSON
Last Name:NOLAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2956
Mailing Address - Country:US
Mailing Address - Phone:662-350-3550
Mailing Address - Fax:
Practice Address - Street 1:1424 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2956
Practice Address - Country:US
Practice Address - Phone:662-350-3550
Practice Address - Fax:662-350-3549
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily