Provider Demographics
NPI:1578795134
Name:WOOD, MELISSA E (CFNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:WOOD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2564
Mailing Address - Country:US
Mailing Address - Phone:601-856-2383
Mailing Address - Fax:
Practice Address - Street 1:106 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-924-9005
Practice Address - Fax:601-925-9463
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003283363LF0000X
MSR901008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V0241Medicare PIN