Healthcare Provider Details

I. General information

NPI: 1558763615
Provider Name (Legal Business Name): MELISSA FIKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANTI

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 NC 55 HWY MINUTECLINIC DIAGNOSTIC OF NORTH CAROLINA
CARY NC
27519-6206
US

IV. Provider business mailing address

2994 KILDAIRE FARM RD
CARY NC
27518-9614
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number253584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: