MEDICARE: MS. KAREN JOAN MELDE NP

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	363LP0200X	Pediatric Nurse Practitioner	RN091317	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN091317	OTHER	GA	RN LICENSURE

General Provider Information

NPI Number	:	1043273923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN JOAN MELDE NP

Provider Business Mailing Address
First Line	:	410 PEACHTREE PKWY STE 4260
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7407
Country	:	US
Telephone Number	:	678-990-2501
Fax Number	:	678-990-2505

Provider Business Practice Location Address
First Line	:	410 PEACHTREE PKWY STE 4260
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7407
Country	:	US
Telephone Number	:	678-990-2501
Fax Number	:	678-990-2505

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	09/11/2018

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