Healthcare Provider Details

I. General information

NPI: 1407303852
Provider Name (Legal Business Name): MELISSA COLEMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/27/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 FEDERAL ST STE B
LYNCHBURG VA
24504-2461
US

IV. Provider business mailing address

130 ADDIE WAY
LYNCHBURG VA
24501-7289
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-6516
  • Fax: 434-200-6263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173880
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: