MEDICARE: MELISSA ANNE BENSON AGPCNP

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	363L00000X	Nurse Practitioner	5005277	NC
2	363LA2200X	Adult Health Nurse Practitioner	5005277	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093096422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE BENSON AGPCNP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	980-488-4900
Fax Number	:	980-488-4905

Provider Business Practice Location Address
First Line	:	10905 PROVIDENCE RD W
Second Line	:	STE G200
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1538
Country	:	US
Telephone Number	:	980-488-4900
Fax Number	:	980-488-4905

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	09/27/2024

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