Healthcare Provider Details

I. General information

NPI: 1508269317
Provider Name (Legal Business Name): MELISSA JOHNSON HURLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BOULEVARD ST
HIGH POINT NC
27262-3802
US

IV. Provider business mailing address

308 BOULEVARD ST
HIGH POINT NC
27262-3802
US

V. Phone/Fax

Practice location:
  • Phone: 336-801-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number227872
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007248
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5007248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: