Provider Demographics
NPI:1033258926
Name:HILL, MELANIE JO (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JO
Last Name:HILL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 BANBURY LN
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8071
Mailing Address - Country:US
Mailing Address - Phone:901-568-7655
Mailing Address - Fax:
Practice Address - Street 1:1021 CASINO CENTER DR
Practice Address - Street 2:CAESAR'S HEALTH AND WELLNESS CENTER
Practice Address - City:ROBINSONVILLE
Practice Address - State:MS
Practice Address - Zip Code:38664-9708
Practice Address - Country:US
Practice Address - Phone:662-357-3264
Practice Address - Fax:662-357-6092
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875859363LF0000X
TNAPN0000011258363LF0000X
TX0000142090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
3641321Medicare ID - Type Unspecified
Q51337Medicare UPIN