Provider Demographics
NPI:1982588661
Name:COULTER, MELISSA LYNNE (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNNE
Last Name:COULTER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2532
Mailing Address - Country:US
Mailing Address - Phone:301-302-4226
Mailing Address - Fax:
Practice Address - Street 1:147 REYNOIR ST STE 307
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4123
Practice Address - Country:US
Practice Address - Phone:228-575-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907669363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care