Provider Demographics
NPI:1245825439
Name:WHITESELL, MELANIE REID (APRN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:REID
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 LATROBE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4823
Mailing Address - Country:US
Mailing Address - Phone:042-660-2327
Mailing Address - Fax:704-312-9565
Practice Address - Street 1:3705 LATROBE DR STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4823
Practice Address - Country:US
Practice Address - Phone:704-266-0232
Practice Address - Fax:704-312-9565
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24979363L00000X
SC390200000X363LP0808X
NC5018524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty