Provider Demographics
NPI:1326201179
Name:SOULE, MELANIE D (NP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:D
Last Name:SOULE
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:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26302-1610
Mailing Address - Country:US
Mailing Address - Phone:304-326-2320
Mailing Address - Fax:304-326-2323
Practice Address - Street 1:16 STERLING DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9132
Practice Address - Country:US
Practice Address - Phone:304-326-2320
Practice Address - Fax:304-326-2323
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42870363L00000X
SC2582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00648641OtherRAILROAD MEDICARE ID
SCP00799638OtherRAILROAD MEDICARE ID-RSFPN
SCNP1265Medicaid
SCP00648641OtherRAILROAD MEDICARE ID
SCNP1265Medicaid