Provider Demographics
NPI:1184670895
Name:BRANNON, MELISSA RUTH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RUTH
Last Name:BRANNON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PLEASANT WAY
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-7600
Mailing Address - Country:US
Mailing Address - Phone:850-865-8260
Mailing Address - Fax:
Practice Address - Street 1:403 W HYMES RD BLDG 843
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-5621
Practice Address - Country:US
Practice Address - Phone:850-883-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered