Provider Demographics
NPI:1467069369
Name:MORGAN, MELISSA MADOLYN (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MADOLYN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MADOLYN
Other - Last Name:NEAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6663
Mailing Address - Country:US
Mailing Address - Phone:901-478-9183
Mailing Address - Fax:901-478-8957
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-478-9183
Practice Address - Fax:901-478-8957
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28062363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology