NPIMap

Individual provider Active NPI

Deseray S Melton, NP

  • Family Nurse Practitioner
  • Jackson, TN
National Provider Identifier
1114695335
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
30302 Issued in TN
Practice address
569 Skyline Dr
Jackson, TN 38301-3911
Phone
(731) 664-7395
NPI assigned
Sep 1, 2021
Last updated
Mar 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 30302 TN Primary
Registered Nurse 163W00000X 200793 TN

Addresses

Primary practice location

569 Skyline Dr
Jackson, TN 38301-3911

Mailing address

569 Skyline Dr
Jackson, TN 38301-3911
Phone (731) 664-7395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230516000259 TN Practitioner - Nurse Practitioner 6406212588 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Tennessee Medical Group IncGroup PAC ID 3971781006, 190 clinicians

Practice addresses (Care Compare)

569 Skyline Dr
Jackson, TN 38301-3911
Phone (731) 421-6510

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3032TNMDProfessional Counselor
200793TNMDRegistered Nurse
30302TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shamrock Community Hospital Inc CurrentSince Sep 17, 2023 Accepting new patients
Lexington Hospital Corporation CurrentSince Sep 17, 2023 Accepting new patients
West Tennessee Medical Group Inc CurrentSince Mar 3, 2025 Accepting new patients
Lexington Hospital Corporation CurrentSince Sep 17, 2023 Accepting new patients
Haywood County Community Hospital Inc CurrentSince Sep 16, 2023 Accepting new patients
Lexington Family Physicians LLC CurrentSince Sep 16, 2023 Accepting new patients
Lexington Clinic Corp CurrentSince Sep 16, 2023 Accepting new patients
Haywood County Community Hospital, Inc CurrentSince Sep 16, 2023 Accepting new patients
Shamrock Community Hospital Inc. CurrentSince Sep 17, 2023 Accepting new patients
Family Medical Clinic of Trezevant PastSince Nov 21, 2021 Accepting new patients
Family Medical Clinic of Trezevant PastSince Nov 1, 2021 Accepting new patients
Jackson Surgical Associates. PA Past Accepting new patients

Locations

2545 N Washington Ave
Brownsville, TN 38012
Phone (731) 307-3777

5001 E Main St
Erin, TN 37061
Phone (336) 944-6420

257 Bancorp South Pkwy
Jackson, TN 38305
Phone (731) 512-1283

569 Skyline Dr
Jackson, TN 38301
Phone (731) 421-6510

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

200 W Church St
Lexington, TN 38351
Phone (731) 968-1812

270 W Church St
Ste A
Lexington, TN 38351
Phone (731) 968-0133

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/henders-823c208a

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1114695335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013911",
            "telephone_number": "731-664-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013911",
            "telephone_number": "731-664-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELTON",
        "first_name": "DESERAY",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "30302",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "200793",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.