Provider Demographics
NPI:1699913202
Name:HAMM, MELANIE RAYE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:RAYE
Last Name:HAMM
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:RAYE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-5159
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:102 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-261-5159
Practice Address - Fax:601-545-1740
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871244363L00000X
MS871244363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03730749Medicaid
MS512I500821Medicare PIN