Provider Demographics
NPI:1457323487
Name:WEST, MELISSA L (CFNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:678-207-4373
Practice Address - Fax:770-533-4727
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA809026985BMedicaid
GA10053108OtherAMERIGROUP
GA344076OtherWELLCARE-HOSPITALIST
GA809026985CMedicaid
GA809026985EMedicaid
GAP00242515OtherRR MEDICARE-GRP # CC4177
GA340911OtherWELLCARE
GA809026985AMedicaid
GA809026985DMedicaid
GAQ30933Medicare UPIN
GA809026985DMedicaid