Provider Demographics
NPI:1245252741
Name:LITTLEJOHN, MELISSA L (CFNP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:L
Last Name:LITTLEJOHN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3049
Mailing Address - Country:US
Mailing Address - Phone:662-316-2209
Mailing Address - Fax:
Practice Address - Street 1:210 HWY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3112
Practice Address - Country:US
Practice Address - Phone:662-507-3330
Practice Address - Fax:662-507-3333
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR732974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06239743Medicaid
MS06239743Medicaid