Provider Demographics
NPI:1093107369
Name:AYCOCK, MELISSA ANNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0298
Mailing Address - Country:US
Mailing Address - Phone:256-767-7494
Mailing Address - Fax:
Practice Address - Street 1:104A PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2100
Practice Address - Country:US
Practice Address - Phone:256-383-6070
Practice Address - Fax:256-381-4022
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily