Provider Demographics
NPI:1669808374
Name:KISER, MELISSA LAMB (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAMB
Last Name:KISER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 WEYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4287
Mailing Address - Country:US
Mailing Address - Phone:770-321-9018
Mailing Address - Fax:
Practice Address - Street 1:3430 WEYMOUTH CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4287
Practice Address - Country:US
Practice Address - Phone:770-321-9018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner