Healthcare Provider Details

I. General information

NPI: 1326428491
Provider Name (Legal Business Name): MELISSA LINCOLN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 POLIFKA DR
SHAW AFB SC
29152-5100
US

IV. Provider business mailing address

420 POLIFKA DR
SHAW AFB SC
29152-5100
US

V. Phone/Fax

Practice location:
  • Phone: 803-885-0239
  • Fax:
Mailing address:
  • Phone: 803-885-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14185694-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: