Provider Demographics
NPI:1124591177
Name:MAYFIELD, MELISSA ANDERSON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANDERSON
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15239 AL HIGHWAY 68 STE B
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-3481
Mailing Address - Country:US
Mailing Address - Phone:256-925-0012
Mailing Address - Fax:256-925-0016
Practice Address - Street 1:15239 AL HIGHWAY 68 STE B
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3481
Practice Address - Country:US
Practice Address - Phone:256-925-0012
Practice Address - Fax:256-925-0016
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty