Provider Demographics
NPI:1821099151
Name:GRISSINGER, MELISSA L (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:GRISSINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-1300
Mailing Address - Fax:423-794-1820
Practice Address - Street 1:301 MED TECH PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-794-1300
Practice Address - Fax:423-794-1820
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74683363LX0001X
TN6189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929043Medicaid
TNQ18283Medicare UPIN
TN3929043Medicare PIN