Provider Demographics
NPI:1548201403
Name:DELANCEY, MELINDA BENNETT
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:BENNETT
Last Name:DELANCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:JORDAN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:215 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1233
Mailing Address - Country:US
Mailing Address - Phone:251-404-3312
Mailing Address - Fax:
Practice Address - Street 1:6766 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8443
Practice Address - Country:US
Practice Address - Phone:601-549-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS825528363L00000X
MSR825528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123607Medicaid
MSP01013951OtherRAILROAD MEDICARE
MS00123607Medicaid
MS7328387OtherAETNA
MS500001105Medicare PIN
MS3140805OtherUHC