Provider Demographics
NPI:1417980871
Name:MAGOON, MELONY E (APN)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:E
Last Name:MAGOON
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 1:9510 HEATHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8933
Mailing Address - Country:US
Mailing Address - Phone:423-265-2271
Mailing Address - Fax:423-785-3454
Practice Address - Street 1:100 MOCCASIN BEND RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4415
Practice Address - Country:US
Practice Address - Phone:423-265-2271
Practice Address - Fax:423-278-5345
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01280Medicare UPIN
TN44-4002Medicare ID - Type Unspecified
TN3282227Medicare ID - Type Unspecified
TN39060091Medicare PIN