Healthcare Provider Details

I. General information

NPI: 1629180849
Provider Name (Legal Business Name): MELISSA D KELLY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 GREEN VALLEY RD STE. 210
GREENSBORO NC
27408-7041
US

IV. Provider business mailing address

1701 WESTCHESTER DR STE. 850
HIGH POINT NC
27262-7008
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-5510
  • Fax: 336-810-5515
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberARNP9169528
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5008997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: