Provider Demographics
NPI:1083229439
Name:DOERING, MELISSA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:DOERING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:HEAPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1054 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3153
Practice Address - Country:US
Practice Address - Phone:843-388-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner