1609844562 NPI number — MS. MELISSA MARTIN BYRD CPCP

Table of content: MS. MELISSA MARTIN BYRD CPCP (NPI 1609844562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609844562 NPI number — MS. MELISSA MARTIN BYRD CPCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRD
Provider First Name:
MELISSA
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CPCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609844562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19283 HIGHWAY 59
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERDALE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36580-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-523-5437
Provider Business Mailing Address Fax Number:
866-628-7517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19283 HIGHWAY 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36580-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-523-5437
Provider Business Practice Location Address Fax Number:
866-628-7517
Provider Enumeration Date:
03/08/2006

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: 363LP0200X , with the licence number:  9200085 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 1-081366 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1275872780 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1063439065 . This is a "NPI GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 011846 . This is a "MEDICARE GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 9200085 . This is a "PEDIATRIC NURSING LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 305877800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630000013 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012089200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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