Healthcare Provider Details

I. General information

NPI: 1760834808
Provider Name (Legal Business Name): MELISSA ANN ALTAMIRANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CHAMPION

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

220 5TH AVE E
HENDERSONVILLE NC
28792-4377
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-4289
  • Fax:
Mailing address:
  • Phone: 828-692-4289
  • Fax: 828-696-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number830190
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number341924
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131277
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: