Provider Demographics
NPI:1982914065
Name:ROSS, MELISSA C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:C
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N WILLOW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2335
Mailing Address - Country:US
Mailing Address - Phone:931-528-8899
Mailing Address - Fax:931-520-7655
Practice Address - Street 1:402 E GORE AVE
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-9367
Practice Address - Country:US
Practice Address - Phone:931-268-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15173363LF0000X
KY3013214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100169440Medicaid
TN1522232Medicaid
TN4338108OtherBCTN
TN1522232Medicaid