Provider Demographics
NPI:1750570677
Name:QUINN, MELINDA LOUISE (CFNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LOUISE
Last Name:QUINN
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 1:10150 COUNTY ROAD 200
Mailing Address - Street 2:
Mailing Address - City:FALKNER
Mailing Address - State:MS
Mailing Address - Zip Code:38629-9707
Mailing Address - Country:US
Mailing Address - Phone:662-512-0139
Mailing Address - Fax:662-512-0438
Practice Address - Street 1:10150 CR 200
Practice Address - Street 2:
Practice Address - City:FALKNER
Practice Address - State:MS
Practice Address - Zip Code:38629-9707
Practice Address - Country:US
Practice Address - Phone:662-512-0139
Practice Address - Fax:662-512-0438
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR764359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner