Provider Demographics
NPI:1427567791
Name:ROBERTSON, MELANIE DAWNE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DAWNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-C
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 511
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-0511
Mailing Address - Country:US
Mailing Address - Phone:601-657-4326
Mailing Address - Fax:601-657-8867
Practice Address - Street 1:102 W FREEDOM DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645
Practice Address - Country:US
Practice Address - Phone:601-657-8091
Practice Address - Fax:601-657-8873
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily