Healthcare Provider Details

I. General information

NPI: 1891435715
Provider Name (Legal Business Name): MELINDA JO CARIE ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 RIDGE RD
NORTH ROYALTON OH
44133-3744
US

IV. Provider business mailing address

2822 S ENLEY RD
WHEATLAND IN
47597-8217
US

V. Phone/Fax

Practice location:
  • Phone: 440-652-8748
  • Fax:
Mailing address:
  • Phone: 812-887-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28145022A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28145022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: