Provider Demographics
NPI:1518349950
Name:UPSHUR, MELINDA BALDUCCI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:BALDUCCI
Last Name:UPSHUR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E SUNFLOWER RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2828
Mailing Address - Country:US
Mailing Address - Phone:662-579-0136
Mailing Address - Fax:662-579-0154
Practice Address - Street 1:810 E SUNFLOWER RD STE 100A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732
Practice Address - Country:US
Practice Address - Phone:662-579-0136
Practice Address - Fax:662-579-0154
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004430363LF0000X
MS865804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004430OtherLICENSE