Healthcare Provider Details

I. General information

NPI: 1538140694
Provider Name (Legal Business Name): MELISSA REGINA COATS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/25/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WILKINSON BLVD
CHARLOTTE NC
28208-5521
US

IV. Provider business mailing address

4000 WILKINSON BLVD STE A
CHARLOTTE NC
28208-5521
US

V. Phone/Fax

Practice location:
  • Phone: 980-202-6526
  • Fax: 855-242-6904
Mailing address:
  • Phone: 980-202-6526
  • Fax: 855-242-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number201437
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: