Provider Demographics
NPI:1871544205
Name:STEPHENS, MELISSA R (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:RENEE
Other - Last Name:CADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:905C S FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-6113
Mailing Address - Country:US
Mailing Address - Phone:601-482-4922
Mailing Address - Fax:601-482-4957
Practice Address - Street 1:905C S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6113
Practice Address - Country:US
Practice Address - Phone:601-482-4922
Practice Address - Fax:601-482-4957
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209057819Medicaid
MO29897032OtherBLUE CROSS BLUE SHIELD OF KC
MO743343OtherHEALTHLINK PIN
MOH41399OtherMERCY HEALTH PLANS PIN
MO7693282OtherAETNA PIN
MOH41399Medicare UPIN
MO29897032OtherBLUE CROSS BLUE SHIELD OF KC
MO209057819Medicaid
KS726B119BMedicare PIN