Healthcare Provider Details

I. General information

NPI: 1770940389
Provider Name (Legal Business Name): MELODYE M HARVEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 ATLANTA HWY
MONTGOMERY AL
36109-3101
US

IV. Provider business mailing address

474 OLD FEDERAL RD
SHORTER AL
36075-3501
US

V. Phone/Fax

Practice location:
  • Phone: 334-323-2260
  • Fax:
Mailing address:
  • Phone: 334-782-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-098175
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-098175
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: