Healthcare Provider Details

I. General information

NPI: 1396600029
Provider Name (Legal Business Name): MELISSA PARKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 CAMBRIDGE WALK
BALTIMORE MD
21224-3659
US

IV. Provider business mailing address

2342 CAMBRIDGE WALK
BALTIMORE MD
21224-3659
US

V. Phone/Fax

Practice location:
  • Phone: 443-452-8122
  • Fax:
Mailing address:
  • Phone: 443-452-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR220340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: