Healthcare Provider Details

I. General information

NPI: 1962327817
Provider Name (Legal Business Name): MELANIE A CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 OFFICE PARK DR
JACKSONVILLE NC
28546-3220
US

IV. Provider business mailing address

2312 INDIAN DR APT D1
JACKSONVILLE NC
28546-5225
US

V. Phone/Fax

Practice location:
  • Phone: 910-543-1234
  • Fax:
Mailing address:
  • Phone: 252-549-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: