Provider Demographics
NPI:1972563369
Name:ALLEN, MELISSA KIMBERLY (NNP-BC, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:KIMBERLY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-893-4480
Mailing Address - Fax:615-893-4480
Practice Address - Street 1:1211 DINAH SHORE BLVED
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1107
Practice Address - Country:US
Practice Address - Phone:931-967-6669
Practice Address - Fax:931-967-6606
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004278363LF0000X
TNAPN06168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1972563369OtherNPI
MN443031000Medicaid
KY78017951Medicaid