Basic Information
| Provider Information | |||||||||
| NPI: | 1962608992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 GODCHAUX HALL | ||||||||
| Address2: | 461 21ST AVENUE SOUTH | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372400001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153433250 | ||||||||
| FaxNumber: | 6153433327 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 SPRINGPLACE RD | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370913447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312704514 | ||||||||
| FaxNumber: | 9312704735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN5698 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 386823-22 | 01 | BOARD CERTIFICATION | OTHER | MN1207631 | 01 | DEA | OTHER |