Provider Demographics
NPI:1043676422
Name:MONROE, MELISSA (MSN, BSN, APRN, AGNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:MSN, BSN, APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S JAMES M CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4334
Mailing Address - Country:US
Mailing Address - Phone:866-668-2188
Mailing Address - Fax:888-794-0549
Practice Address - Street 1:1119 E COLLEGE ST STE 3
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4564
Practice Address - Country:US
Practice Address - Phone:931-347-9125
Practice Address - Fax:931-347-9127
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20881207QA0505X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine