Provider Demographics
NPI:1548652548
Name:CHITTUM, MELISSA (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CHITTUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 PARK WEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4330
Mailing Address - Country:US
Mailing Address - Phone:865-690-7677
Mailing Address - Fax:865-690-7627
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4330
Practice Address - Country:US
Practice Address - Phone:865-690-7677
Practice Address - Fax:865-690-7627
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19661363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology