Provider Demographics
NPI:1427261072
Name:HALLEY, MELISSA S (RN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:S
Last Name:HALLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VIEW ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5723
Mailing Address - Country:US
Mailing Address - Phone:423-837-9307
Mailing Address - Fax:
Practice Address - Street 1:110 GAMBLE LN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-2811
Practice Address - Country:US
Practice Address - Phone:423-942-2238
Practice Address - Fax:423-942-1986
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000095735163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health