Provider Demographics
NPI:1023451622
Name:BENNETT, MELISSA ANN (DVM)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4103
Mailing Address - Country:US
Mailing Address - Phone:865-688-0776
Mailing Address - Fax:
Practice Address - Street 1:5630 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-4103
Practice Address - Country:US
Practice Address - Phone:865-688-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3311174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian