Provider Demographics
NPI:1821629494
Name:GREYWITT, MELISSA LEEANN (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEEANN
Last Name:GREYWITT
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 1:501 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2219
Mailing Address - Country:US
Mailing Address - Phone:305-923-2309
Mailing Address - Fax:
Practice Address - Street 1:501 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2219
Practice Address - Country:US
Practice Address - Phone:305-923-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27221363LF0000X
TNF01201915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000OtherNA