Provider Demographics
NPI:1346208121
Name:MARTINO, MELANIE S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:S
Last Name:MARTINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHERIDAN SQ
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7390
Mailing Address - Country:US
Mailing Address - Phone:423-392-6840
Mailing Address - Fax:423-392-6845
Practice Address - Street 1:3 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7390
Practice Address - Country:US
Practice Address - Phone:423-392-6840
Practice Address - Fax:423-392-6845
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN115031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928282Medicaid
Q16986Medicare UPIN
TN3928283Medicare PIN