Melissa Waybrant-Ennis, APRN, DNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11003223 Issued in FL

Practice address

5964 US Highway 90
Live Oak, FL 32060-8694

Phone

(302) 981-8484

Fax

(833) 672-3395

NPI assigned

Apr 14, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Florida Department of Children and Families

  • General Acute Care Hospital
  • Chattahoochee, FL
  • NPI 1710945118

  FL

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  FL

  Medicare reassignment NPD
• Florida Department of Children and Families

  • Psychiatric Hospital
  • Macclenny, FL
  • NPI 1013931765
  NPD

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

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1780118885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5964 US HIGHWAY 90",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320608694",
            "telephone_number": "302-981-8484",
            "fax_number": "833-672-3395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5964 US HIGHWAY 90",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320608694",
            "telephone_number": "302-981-8484",
            "fax_number": "833-672-3395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYBRANT-ENNIS",
        "first_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "APRN, DNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-14",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015760",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209015760",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11003223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104165900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN",
            "identifier": "11003223",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCED PRACTICE NURSE",
            "identifier": "209015760",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walmart Pharmacy
• Lana Ward
• Elvin F Warren III
• Zahoor A. Waseem, MD
• Barrinesha Deshawn Washington, MBA
• Penny Ann West, APRN
• Demaycia Jemirea Wheeler
• Teri Lynn Wilhoite, LMT
• Kristin N Williams
• Melania J Willis, ARNP

• All providers in Live Oak, FL
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.