Provider Demographics
NPI:1861011553
Name:PREWITT, ASHLEY MELANCON (PMHNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MELANCON
Last Name:PREWITT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WESTWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3592
Mailing Address - Country:US
Mailing Address - Phone:601-668-1397
Mailing Address - Fax:
Practice Address - Street 1:201 N COLLEGE ST STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-4439
Practice Address - Country:US
Practice Address - Phone:601-825-6010
Practice Address - Fax:601-825-7146
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906947163W00000X
MS904890363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse