Provider Demographics
NPI:1760016265
Name:GRAVES, MELONIE SHOWERS (NP)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:SHOWERS
Last Name:GRAVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWHEBRON
Mailing Address - State:MS
Mailing Address - Zip Code:39140-3809
Mailing Address - Country:US
Mailing Address - Phone:601-694-2116
Mailing Address - Fax:855-447-0640
Practice Address - Street 1:202 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEWHEBRON
Practice Address - State:MS
Practice Address - Zip Code:39140-3809
Practice Address - Country:US
Practice Address - Phone:601-694-2116
Practice Address - Fax:855-447-0640
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily