Provider Demographics
NPI:1326524091
Name:NEVITT, MELISSA FAY (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAY
Last Name:NEVITT
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 1:1508 S BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2668
Mailing Address - Country:US
Mailing Address - Phone:256-259-3600
Mailing Address - Fax:256-259-3601
Practice Address - Street 1:1508 S BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768
Practice Address - Country:US
Practice Address - Phone:256-259-3600
Practice Address - Fax:256-259-3601
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF05180834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF05180834OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS