Provider Demographics
NPI:1538296496
Name:PHILLIPS FREEMAN, MELINDA L (APN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:PHILLIPS FREEMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 HIGHWAY 48 N
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FURNACE
Mailing Address - State:TN
Mailing Address - Zip Code:37051-4760
Mailing Address - Country:US
Mailing Address - Phone:615-838-6682
Mailing Address - Fax:
Practice Address - Street 1:199 HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2076
Practice Address - Country:US
Practice Address - Phone:615-326-8361
Practice Address - Fax:615-326-8468
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12498363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1503984Medicaid
TN4336559OtherBLUE CROSS BLUE SHIELD
TN4336559OtherBLUE CROSS BLUE SHIELD