Provider Demographics
NPI:1609081660
Name:JUSTICE, MELISSA GAY (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAY
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:APRN BC
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Mailing Address - Street 1:1506 SHARPS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2870
Mailing Address - Country:US
Mailing Address - Phone:423-912-1127
Mailing Address - Fax:423-563-7588
Practice Address - Street 1:402 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2530
Practice Address - Country:US
Practice Address - Phone:423-563-7553
Practice Address - Fax:423-563-7588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TN0000005189363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care