Healthcare Provider Details

I. General information

NPI: 1336858166
Provider Name (Legal Business Name): MELANIE OGBURN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 INDUSTRIAL DR
LOUISA VA
23093-4187
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1802 PMB 715264
NORFOLK VA
23510-1146
US

V. Phone/Fax

Practice location:
  • Phone: 540-967-9401
  • Fax: 855-532-6831
Mailing address:
  • Phone: 540-209-9778
  • Fax: 855-532-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114901
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: