Organization
DIABETES CLINIC OF THE COAST, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELONIE R ROBERTS FNP-BC (OWNER)
(228) 697-8244
Entity
Organization
Contact information
Practice address
1110 BROAD AVE, SUITE 600, GULFPORT, MS 39501-8907
(228) 220-1588
(228) 220-1581
Mailing address
PO BOX 863, PASS CHRISTIAN, MS 39571-0419
(228) 220-1588
(228) 220-1581
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R874839
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285902841
NPI
MS
Enumeration date
11/04/2015
Last updated
11/04/2015
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