Provider Demographics
NPI:1881634442
Name:CARTER, MELISSA M (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37070-0710
Mailing Address - Country:US
Mailing Address - Phone:615-859-1440
Mailing Address - Fax:615-859-0145
Practice Address - Street 1:450 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2180
Practice Address - Country:US
Practice Address - Phone:615-859-1440
Practice Address - Fax:615-859-0145
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3665064Medicare PIN