Provider Demographics
NPI:1184960437
Name:FLANAGIN, MELISSA EASLEY (NNP)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:EASLEY
Last Name:FLANAGIN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 320039
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-957-7345
Mailing Address - Fax:769-251-5924
Practice Address - Street 1:5 RIVER BEND PLACE
Practice Address - Street 2:SUITE C
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-957-7345
Practice Address - Fax:769-251-5429
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883213363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00079248Medicaid