MEDICARE: MRS. ALLISON RENEE MELTON FNP-BC

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	5005627	NC

General Provider Information

NPI Number	:	1457612012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON RENEE MELTON FNP-BC

Provider Business Mailing Address
First Line	:	308 US HIGHWAY 17 N
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-7828
Country	:	US
Telephone Number	:	910-329-1707
Fax Number	:	910-329-1716

Provider Business Practice Location Address
First Line	:	308 US HIGHWAY 17 N
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-7828
Country	:	US
Telephone Number	:	910-329-1707
Fax Number	:	910-329-1716

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/21/2013

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