Provider Demographics
NPI:1609844562
Name:BYRD, MELISSA MARTIN (APRN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARTIN
Last Name:BYRD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7552
Mailing Address - Country:US
Mailing Address - Phone:850-436-4630
Mailing Address - Fax:850-912-6979
Practice Address - Street 1:2701 N Q ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5615
Practice Address - Country:US
Practice Address - Phone:850-912-6006
Practice Address - Fax:850-912-6979
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081366363LP0200X
FL9200085363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9200085OtherPEDIATRIC NURSING LICENSE
AL011846OtherMEDICARE GROUP PAYEE NUMBER
FL305877800Medicaid
AL1063439065OtherNPI GROUP PAYEE NUMBER
FL1275872780OtherGROUP NPI
AL630000013Medicaid