Provider Demographics
NPI:1538854880
Name:RADER, MELISSA GAYLE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
Last Name:RADER
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 S CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1107
Mailing Address - Country:US
Mailing Address - Phone:423-290-7981
Mailing Address - Fax:
Practice Address - Street 1:513 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3402
Practice Address - Country:US
Practice Address - Phone:423-531-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner