Provider Demographics
NPI:1891976064
Name:FEDERICI, MELISSA A (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FEDERICI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-673-5000
Mailing Address - Fax:865-588-5711
Practice Address - Street 1:1342 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-673-5000
Practice Address - Fax:865-588-5711
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1862363A00000X
TNPA1862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522184Medicaid
TN10397I6359Medicare PIN