Provider Demographics
NPI:1245428788
Name:WALDROP, MELANIE JOAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOAN
Last Name:WALDROP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:JOAN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 HWY 61N
Mailing Address - Street 2:RIVER REGION MEDICAL CENTER
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183
Mailing Address - Country:US
Mailing Address - Phone:601-883-5000
Mailing Address - Fax:
Practice Address - Street 1:2100 HWY 61N
Practice Address - Street 2:RIVER REGION MEDICAL CENTER
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183
Practice Address - Country:US
Practice Address - Phone:601-883-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-048875367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR886621OtherMISSISSIPPI RN/ADVANCED PRACTICE/CRNA LICENSE
AL1 048875OtherALABAMA RN/ADVANCED PRACTICE/CRNA LICENSE