Provider Demographics
NPI:1720659758
Name:FRIERSON, MELANIE LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 FRIERSON RD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-8132
Mailing Address - Country:US
Mailing Address - Phone:601-273-1670
Mailing Address - Fax:
Practice Address - Street 1:153 FRIERSON RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-8132
Practice Address - Country:US
Practice Address - Phone:601-273-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS894335163W00000X
MS904383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse