Provider Demographics
NPI:1821510835
Name:DAVIS, MELISSA DIANNE (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANNE
Last Name:DAVIS
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 1:1935 ED DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-7219
Mailing Address - Country:US
Mailing Address - Phone:334-343-7098
Mailing Address - Fax:
Practice Address - Street 1:135 MEDICAL PARK DR STE 1A
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5353
Practice Address - Country:US
Practice Address - Phone:334-222-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9460845363LF0000X
AL1-054557363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily