Individual
MELISSA LYNN FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
507 WALLACE ST, MENDENHALL, MS 39114-3807
(769) 229-1940
Mailing address
507 WALLACE ST, MENDENHALL, MS 39114-3807
(769) 229-1940
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
07/20/2020
Last updated
11/19/2020
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