Healthcare Provider Details

I. General information

NPI: 1497054530
Provider Name (Legal Business Name): MELISSA FAYE MORENINGS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD SUITE 458W
BRISTOL TN
37620-7430
US

IV. Provider business mailing address

105 W STONE DR SUITE 6A
KINGSPORT TN
37660-3365
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-4800
  • Fax: 423-230-6905
Mailing address:
  • Phone: 423-408-7220
  • Fax: 423-408-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169282
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19518
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: