Healthcare Provider Details

I. General information

NPI: 1093550014
Provider Name (Legal Business Name): MELANIE LYNN MOLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FRANKLIN SQUARE WAY
EASLEY SC
29642-3715
US

IV. Provider business mailing address

1007 LANGO AVE
CHARLESTON SC
29407-6427
US

V. Phone/Fax

Practice location:
  • Phone: 803-645-2000
  • Fax:
Mailing address:
  • Phone: 843-532-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number28953
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: