Provider Demographics
NPI:1174081905
Name:HOLTON, MELISSA DAWN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:HOLTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 YELLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-5061
Mailing Address - Country:US
Mailing Address - Phone:407-436-5092
Mailing Address - Fax:
Practice Address - Street 1:1052 YELLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-5061
Practice Address - Country:US
Practice Address - Phone:407-436-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000025530363L00000X
TN25530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily