Healthcare Provider Details

I. General information

NPI: 1013662402
Provider Name (Legal Business Name): MELISSA CLARKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 FAUNCE CORNER RD
DARTMOUTH MA
02747-1242
US

IV. Provider business mailing address

208 MILL RD
FAIRHAVEN MA
02719-5208
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3991
  • Fax:
Mailing address:
  • Phone: 508-758-3781
  • Fax: 508-758-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2309708
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: