Provider Demographics
NPI:1861757171
Name:BUPP, MELISSA JONES (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JONES
Last Name:BUPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0260
Mailing Address - Country:US
Mailing Address - Phone:706-202-7828
Mailing Address - Fax:
Practice Address - Street 1:501 MOUNT VERNON RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-5028
Practice Address - Country:US
Practice Address - Phone:706-202-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176757363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health