Active NPI
Shawntae Renea Melvin, FNP
- Family Nurse Practitioner
- Brandon, MS
National Provider Identifier
1124528997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 902508
- Practice address
- 513 Eternal CT
Brandon, MS 39042-4430 - Phone
- (601) 706-4671
- NPI assigned
- Feb 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 902508 | MS | Primary |
Addresses
Primary practice location
513 Eternal CT
Brandon, MS 39042-4430
Mailing address
513 Eternal CT
Brandon, MS 39042-4430
Phone (601) 706-4671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902508 | MS | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518912000000",
"number": "1124528997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "513 ETERNAL CT",
"city": "BRANDON",
"state": "MS",
"postal_code": "390424430",
"telephone_number": "601-706-4671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 ETERNAL CT",
"city": "BRANDON",
"state": "MS",
"postal_code": "390424430",
"telephone_number": "601-706-4671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELVIN",
"first_name": "SHAWNTAE",
"middle_name": "RENEA",
"name_prefix": "Mrs.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-18",
"last_updated": "2018-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "902508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.