1346580818 NPI number — MRS. MELISSA LEIGH GLASSON LSW

Table of content: MRS. MELISSA LEIGH GLASSON LSW (NPI 1346580818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346580818 NPI number — MRS. MELISSA LEIGH GLASSON LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASSON
Provider First Name:
MELISSA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIELDS
Provider Other First Name:
MELISSA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346580818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2434 S EASON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38804-6942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-844-1717
Provider Business Mailing Address Fax Number:
662-680-6416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2434 S EASON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38804-6942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-844-1717
Provider Business Practice Location Address Fax Number:
662-680-6416
Provider Enumeration Date:
02/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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