MEDICARE: MELANIE GAIL NICHOLS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71009708A	IN

General Provider Information

NPI Number	:	1548804552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE GAIL NICHOLS FNP-C

Provider Business Mailing Address
First Line	:	2620 ELM HILL PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 NATIONAL ROAD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-2200
Country	:	US
Telephone Number	:	812-314-7955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	01/24/2020

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