Provider Demographics
NPI:1588025373
Name:MINOR, MELISSA N (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:N
Last Name:MINOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ABUNDANCE XING
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-6618
Mailing Address - Country:US
Mailing Address - Phone:601-807-4035
Mailing Address - Fax:601-952-4288
Practice Address - Street 1:805 E RIVER PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3486
Practice Address - Country:US
Practice Address - Phone:601-364-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPA00279OtherMS LICENSE