Provider Demographics
NPI:1306012026
Name:HARRISON, MELODY (APN)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-0700
Mailing Address - Country:US
Mailing Address - Phone:931-598-5648
Mailing Address - Fax:931-598-9984
Practice Address - Street 1:161 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2256
Practice Address - Country:US
Practice Address - Phone:931-962-0470
Practice Address - Fax:931-962-0450
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005673364SF0001X
TNAPN5673363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health