Provider Demographics
NPI:1699240473
Name:CROSBY, MELISSA ALLISON (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALLISON
Last Name:CROSBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 J DEWEY GRAY CIR STE 210
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6554
Mailing Address - Country:US
Mailing Address - Phone:706-922-7670
Mailing Address - Fax:706-922-7680
Practice Address - Street 1:222 E MEDICAL LN STE 101
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4850
Practice Address - Country:US
Practice Address - Phone:803-739-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192335363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily