Provider Demographics
NPI:1851309611
Name:PREVATTE, MELISSA D (APN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:PREVATTE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 PRESIDENT PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6807
Mailing Address - Country:US
Mailing Address - Phone:615-459-7104
Mailing Address - Fax:615-459-7822
Practice Address - Street 1:741 PRESIDENT PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6807
Practice Address - Country:US
Practice Address - Phone:615-459-7104
Practice Address - Fax:615-459-7822
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000087576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4108341OtherBCBS
TN3902276Medicaid
3902276Medicare ID - Type Unspecified
4108341OtherBCBS