Healthcare Provider Details

I. General information

NPI: 1942133145
Provider Name (Legal Business Name): PREMIER NP CLINICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15415 SHAMROCK RD SW
CUMBERLAND MD
21502-5842
US

IV. Provider business mailing address

15415 SHAMROCK RD SW
CUMBERLAND MD
21502-5842
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-6192
  • Fax: 240-362-6192
Mailing address:
  • Phone: 240-362-6192
  • Fax: 240-362-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MELLOTT
Title or Position: CRNP
Credential: FNP-C
Phone: 240-362-6192