Provider Demographics
NPI:1851373344
Name:WARD, MELISSA DAWN (CRNP)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DAWN
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:710 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-1508
Mailing Address - Country:US
Mailing Address - Phone:256-800-2105
Mailing Address - Fax:256-800-2107
Practice Address - Street 1:710 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-1508
Practice Address - Country:US
Practice Address - Phone:256-800-2105
Practice Address - Fax:256-800-2107
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051518176TAYOtherBC/BS ALABAMA
AL1851373344Medicaid
AL529702470Medicaid
ALP92983Medicare UPIN
AL510I500390Medicare PIN