1205833142 NPI number — DR. HEATHER ANNE MELTON MD

Table of content: DR. HEATHER ANNE MELTON MD (NPI 1205833142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205833142 NPI number — DR. HEATHER ANNE MELTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELTON
Provider First Name:
HEATHER
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GULISH
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205833142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 RIDGE LAKE BLVD STE 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-9401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22700 HIGHWAY 22 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KENZIE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38201-8679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-986-7200
Provider Business Practice Location Address Fax Number:
731-986-7292
Provider Enumeration Date:
07/07/2005

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: 207X00000X , with the licence number:  37119 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000353340 . This is a "BCBSKY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64082274 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124048541 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00131527 . This is a "PALMETO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2122712 . This is a "FIRST HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4058520 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3881222 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7469524 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1205833142 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 40903919 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 143389 . This is a "UNISON" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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