Provider Demographics
NPI:1427743657
Name:ANON, MELANIE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ANON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GERMANTOWN CT STE 402
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4275
Mailing Address - Country:US
Mailing Address - Phone:901-752-4900
Mailing Address - Fax:901-752-4902
Practice Address - Street 1:65 GERMANTOWN CT STE 402
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4275
Practice Address - Country:US
Practice Address - Phone:901-752-4900
Practice Address - Fax:901-752-4902
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000032284363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health