Provider Demographics
NPI:1356734081
Name:GASPAR, MELISSA DAWN (APRN, CNM, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:GASPAR
Suffix:
Gender:F
Credentials:APRN, CNM, FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:MCDUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNM
Mailing Address - Street 1:117 OWL HOOT RD
Mailing Address - Street 2:
Mailing Address - City:PERKINSTON
Mailing Address - State:MS
Mailing Address - Zip Code:39573-4337
Mailing Address - Country:US
Mailing Address - Phone:406-217-1625
Mailing Address - Fax:
Practice Address - Street 1:2003 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2178
Practice Address - Country:US
Practice Address - Phone:985-646-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100052363LF0000X, 367A00000X
MS906642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7173621Medicaid
MT9903699Medicaid