Healthcare Provider Details

I. General information

NPI: 1679149223
Provider Name (Legal Business Name): MELANIE ALDRIDGE BRADFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MULBERRY ST SW
LENOIR NC
28645-5720
US

IV. Provider business mailing address

235 TWEETSIE LN W
BANNER ELK NC
28604-6619
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5504
  • Fax: 828-757-5225
Mailing address:
  • Phone: 828-773-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberBRAD-YM4R5
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: