Healthcare Provider Details

I. General information

NPI: 1073037339
Provider Name (Legal Business Name): MELISSA MARIE KRIVANEK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MEDICAL CENTER DR
WILMINGTON NC
28401-7306
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 910-838-5788
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020285
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024025476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: