MEDICARE: MRS. MELISSA VANN-COMBS FNP

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	164W00000X	Licensed Practical Nurse	0002056040	VA
2	363LF0000X	Family Nurse Practitioner	0024183794	VA

General Provider Information

NPI Number	:	1457696494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA VANN-COMBS FNP

Provider Business Mailing Address
First Line	:	2678 BOLIVER RD
Second Line	:
City	:	FORT VALLEY
State	:	VA
Zip	:	22652-2424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2678 BOLIVER RD
Second Line	:
City	:	FORT VALLEY
State	:	VA
Zip	:	22652-2424
Country	:	US
Telephone Number	:	540-933-6021
Fax Number	:

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

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	02/23/2022

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