Provider Demographics
NPI:1235426370
Name:MARTINEZ, MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0748
Mailing Address - Country:US
Mailing Address - Phone:828-670-7077
Mailing Address - Fax:828-670-7035
Practice Address - Street 1:200 RIDGEFIELD CT
Practice Address - Street 2:STE 220
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2337
Practice Address - Country:US
Practice Address - Phone:828-670-7077
Practice Address - Fax:828-670-7035
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101617Medicaid
NCNC3436AOtherMEDICARE PTAN