Provider Demographics
NPI:1770874836
Name:DEVER-MOUNT, MELISSA L (PMHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:DEVER-MOUNT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3617 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-8957
Mailing Address - Country:US
Mailing Address - Phone:541-535-6239
Mailing Address - Fax:541-512-1026
Practice Address - Street 1:3617 S PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-8957
Practice Address - Country:US
Practice Address - Phone:541-535-6239
Practice Address - Fax:541-512-1026
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737855363LP0808X
OR201407387NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678123Medicaid