Provider Demographics
NPI:1962058792
Name:PHILLIPS, MELISSA ANN (MSPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 DR CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-6209
Mailing Address - Country:US
Mailing Address - Phone:386-313-7264
Mailing Address - Fax:386-437-8207
Practice Address - Street 1:206 DR CARTER BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6209
Practice Address - Country:US
Practice Address - Phone:386-313-7264
Practice Address - Fax:386-437-8207
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty