Individual provider Active NPI

Melissa Lynn Marino

  • Acute Care Nurse Practitioner
  • Gideon, MO
National Provider Identifier
1174358568
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
39459 Issued in TN
Practice address
100 N Main St
Gideon, MO 63848-9253
Phone
(870) 838-7300
NPI assigned
Sep 4, 2024
Last updated
Sep 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 236794 AR
Acute Care Nurse Practitioner 363LA2100X 39459 TN Primary
Acute Care Nurse Practitioner 363LA2100X 2026012430 MO
Gerontology Nurse Practitioner 363LG0600X 39459 TN

Addresses

Primary practice location

100 N Main St
Gideon, MO 63848-9253

Mailing address

1520 N Division St
Blytheville, AR 72315-1448
Phone (870) 838-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MO, AR3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20251117002338 TN Practitioner - Nurse Practitioner 3274024344 Reassigns benefits to 1 organization
I20260330002903 MO Practitioner - Nurse Practitioner 3274024344 Reassigns benefits to 1 organization
I20260409001021 AR Practitioner - Nurse Practitioner 3274024344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 N Main St
Gideon, MO 63848-9253

326 S Mount Auburn Rd
Cape Girardeau, MO 63703-4907

350 N Humpheys Blvd
Memphis, TN 38120-2177

901 W Commercial St
Kennett, MO 63857-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39459TNMDPediatrics Physician
236794ARMDAcute Care Nurse Practitioner
2026012430MOMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Memorial Medical Group Inc CurrentSince Sep 29, 2025 Accepting new patients
Baptist Memorial Medical Group Inc CurrentSince Sep 29, 2025 Accepting new patients
Baptist Memorial Health Services, Inc. of Mississippi Past Accepting new patients

Locations

36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801

350 N Humphreys Blvd
Memphis, TN 38120
Phone (901) 226-4003

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

6019 Walnut Grove Rd
#4E
Memphis, TN 38120
Phone (901) 226-0732

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1174358568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N DIVISION ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151448",
            "telephone_number": "870-838-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "GIDEON",
            "state": "MO",
            "postal_code": "638489253",
            "telephone_number": "870-838-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "MELISSA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-04",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "236794",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "39459",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2026012430",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "39459",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gideon, MO

Sources for this page

Verify at the official NPI Registry.