Provider Demographics
NPI:1235157850
Name:MELLETTE, CAROLYN ALICE (FNPC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ALICE
Last Name:MELLETTE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:720-493-9006
Mailing Address - Fax:720-242-7520
Practice Address - Street 1:9218 KIMMER DR STE 207
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6733
Practice Address - Country:US
Practice Address - Phone:720-493-9006
Practice Address - Fax:720-242-7520
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0004396-NP363L00000X
CO140631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ47759Medicare UPIN
COC804061Medicare PIN