Provider Demographics
NPI:1851946727
Name:HILL, MELISSA BROOKE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BROOKE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3584
Mailing Address - Country:US
Mailing Address - Phone:318-548-2412
Mailing Address - Fax:
Practice Address - Street 1:102 THOMAS RD STE 107
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7365
Practice Address - Country:US
Practice Address - Phone:318-329-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty