Provider Demographics
NPI:1043752579
Name:HANKS, MELODIE GRAHAM PATTON (NP)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:GRAHAM PATTON
Last Name:HANKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELODIE
Other - Middle Name:GRAHAM
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 SILVERBELL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6748
Mailing Address - Country:US
Mailing Address - Phone:864-580-9364
Mailing Address - Fax:
Practice Address - Street 1:220 FAISON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3210
Practice Address - Country:US
Practice Address - Phone:803-935-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107384163W00000X
SC20670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC98096067OtherMEDICARE PIN
SCSC98096121OtherMEDICARE PIN
SCNP4313Medicaid
SCSC98096067OtherMEDICARE PIN