MEDICARE: MRS. MARY RYAN MELIN F.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024195707	VA
2	363LF0000X	Family Nurse Practitioner	18486	SC

General Provider Information

NPI Number	:	1023444767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY RYAN MELIN F.N.P.

Provider Business Mailing Address
First Line	:	2073 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5834
Country	:	US
Telephone Number	:	843-571-0643
Fax Number	:	843-571-0311

Provider Business Practice Location Address
First Line	:	2073 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5834
Country	:	US
Telephone Number	:	843-571-0643
Fax Number	:	843-571-0311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	03/16/2026

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