Healthcare Provider Details

I. General information

NPI: 1619354586
Provider Name (Legal Business Name): MELISSA NICOLE CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

9250 BRUCKHAUS ST APT.202
RALEIGH NC
27617-4406
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-7030
  • Fax:
Mailing address:
  • Phone: 919-332-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number248751
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2014015355
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: