Provider Demographics
NPI:1114042892
Name:SMITH, MELYNDA WHITMER (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:WHITMER
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW CARY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8444
Mailing Address - Country:US
Mailing Address - Phone:919-319-9219
Mailing Address - Fax:
Practice Address - Street 1:3600 NORTHWEST CARY PKWY.
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8457
Practice Address - Country:US
Practice Address - Phone:781-721-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011157363LF0000X, 363LF0000X
IN71002329A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200935410Medicaid
IN068010137Medicare PIN
IN264430272Medicare PIN