Provider Demographics
NPI:1619242443
Name:LAYNE, MELISSA V (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:V
Last Name:LAYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:115 JUDGE GRESHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6213
Practice Address - Country:US
Practice Address - Phone:423-477-2885
Practice Address - Fax:423-477-0113
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2016-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN16565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I505741Medicare PIN
TN103I502829Medicare PIN