MEDICARE: MELANIE LOUISE KEITH FNP-BC

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	AP10284	AZ
2	363LF0000X	Family Nurse Practitioner	RN2389822	MA

General Provider Information

NPI Number	:	1891216164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE LOUISE KEITH FNP-BC

Provider Business Mailing Address
First Line	:	45 TRADERS WAY APT 30113
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-1387
Country	:	US
Telephone Number	:	520-256-3126
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 DODGE ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1705
Country	:	US
Telephone Number	:	617-865-2749
Fax Number	:

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	07/07/2024

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