Provider Demographics
NPI:1487861886
Name:NIX, MELINDA B (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:B
Last Name:NIX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7976 CHESTERFIELD DR S
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6201
Mailing Address - Country:US
Mailing Address - Phone:662-280-5547
Mailing Address - Fax:662-280-5165
Practice Address - Street 1:7976 CHESTERFIELD DR S
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6201
Practice Address - Country:US
Practice Address - Phone:662-280-5547
Practice Address - Fax:662-280-5165
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP139629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse