Provider Demographics
NPI:1063664647
Name:MELENDEZ, JESUS M (APN)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 PEERLESS XING NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3784
Mailing Address - Country:US
Mailing Address - Phone:423-479-4165
Mailing Address - Fax:423-478-1884
Practice Address - Street 1:1060 PEERLESS XING NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3784
Practice Address - Country:US
Practice Address - Phone:423-479-4165
Practice Address - Fax:423-478-1884
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511396Medicaid
TN103I509255Medicare PIN