Provider Demographics
NPI:1316224728
Name:HALLORAN, MELODY L (NP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 JAY TRENT CT
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5750
Mailing Address - Country:US
Mailing Address - Phone:423-255-7874
Mailing Address - Fax:423-255-7874
Practice Address - Street 1:1815 E 32ND ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37407-1721
Practice Address - Country:US
Practice Address - Phone:423-493-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily