Healthcare Provider Details

I. General information

NPI: 1477171031
Provider Name (Legal Business Name): MELISSA GREENHALGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 TWO NOTCH RD
LEXINGTON SC
29072-7963
US

IV. Provider business mailing address

2480 TWO NOTCH RD
LEXINGTON SC
29072-7963
US

V. Phone/Fax

Practice location:
  • Phone: 803-951-5871
  • Fax:
Mailing address:
  • Phone: 803-951-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number667702
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345918
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25311
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: