Provider Demographics
NPI:1134227176
Name:BIBB, MELISSA GAYLE (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAYLE
Last Name:BIBB
Suffix:
Gender:F
Credentials:CPNP-PC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:POB 2, SUITE 401
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-933-5599
Mailing Address - Fax:205-930-2611
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:POB 2, SUITE 401
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-5599
Practice Address - Fax:205-930-2611
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-035605363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-36006OtherBLUE CROSS BLUE SHIELD