Basic Information
| Provider Information | |||||||||
| NPI: | 1972563369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | KIMBERLY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | NNP-BC, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1272 GARRISON DR | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934480 | ||||||||
| FaxNumber: | 6158934480 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 DINAH SHORE BLVED | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373981107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319676669 | ||||||||
| FaxNumber: | 9319676606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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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 | 3004278 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN06168 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1972563369 | 01 | TN | NPI | OTHER | 443031000 | 05 | MN | MEDICAID | 78017951 | 05 | KY | MEDICAID |