Provider Demographics
NPI:1376060715
Name:BARKER-MUTCHMORE, MELINDA (NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BARKER-MUTCHMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:GAYE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 ENGLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0924
Mailing Address - Country:US
Mailing Address - Phone:931-528-7531
Mailing Address - Fax:
Practice Address - Street 1:701 COUNTY SERVICES DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4338
Practice Address - Country:US
Practice Address - Phone:931-528-2531
Practice Address - Fax:931-526-7451
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23084363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032588Medicaid