Provider Demographics
NPI:1437732138
Name:BROWN, MELISSA GAIL
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 PARKS LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:TN
Mailing Address - Zip Code:37366-3405
Mailing Address - Country:US
Mailing Address - Phone:931-308-6654
Mailing Address - Fax:
Practice Address - Street 1:106 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3556
Practice Address - Country:US
Practice Address - Phone:931-222-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily