Healthcare Provider Details

I. General information

NPI: 1619506516
Provider Name (Legal Business Name): MELISSA JOY HAYNES MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA JOY LEPPERT

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CADMUS LN STE 209
EASTON MD
21601-4094
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1000
  • Fax:
Mailing address:
  • Phone: 443-462-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRR249096
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: