Individual
MRS. MELISSA BARHAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
971 LAKELAND DR STE 557, JACKSON, MS 39216-4661
(601) 200-4560
(601) 200-4580
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4560
(601) 200-4580
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902715
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04520717
—
MS
Enumeration date
07/16/2018
Last updated
10/27/2021
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