Provider Demographics
NPI:1467231662
Name:CARTER, MELISSA LYNETTE (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNETTE
Last Name:CARTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-2127
Mailing Address - Country:US
Mailing Address - Phone:662-822-2231
Mailing Address - Fax:
Practice Address - Street 1:1732 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-2127
Practice Address - Country:US
Practice Address - Phone:662-822-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2166133V00000X
MSD1412133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered