Provider Demographics
NPI:1083164404
Name:MCCULLEY, MELODY GRACE (DNP, APN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:GRACE
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 ROUTE 70 E STE 201
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:733 ROUTE 70 E STE 201
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2335
Practice Address - Country:US
Practice Address - Phone:609-451-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18737400163W00000X
NJF06211160363LF0000X
NJ26NJ01175900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse