Provider Demographics
NPI:1720749799
Name:SEYMOUR, MELANEE (PA)
Entity type:Individual
Prefix:
First Name:MELANEE
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 LORRAINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5053
Mailing Address - Country:US
Mailing Address - Phone:720-254-8634
Mailing Address - Fax:228-203-3506
Practice Address - Street 1:8927 LORRAINE RD STE 101
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5053
Practice Address - Country:US
Practice Address - Phone:720-254-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical