Provider Demographics
NPI:1679636146
Name:MALLEY, MELISSA JANE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:MALLEY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 JIM HORTON COURT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:561-312-6406
Mailing Address - Fax:
Practice Address - Street 1:820 N THOMPSON LN STE 1H
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4340
Practice Address - Country:US
Practice Address - Phone:615-553-5000
Practice Address - Fax:615-758-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27478363LF0000X, 363L00000X
FLRN2958212174400000X
TX657809363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health