Provider Demographics
NPI:1366473605
Name:CLARKE, MELISSA P (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:P
Last Name:CLARKE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:P
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7900 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4215
Mailing Address - Country:US
Mailing Address - Phone:804-288-1953
Mailing Address - Fax:804-282-1046
Practice Address - Street 1:8237 MEADOWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2329
Practice Address - Country:US
Practice Address - Phone:804-559-7634
Practice Address - Fax:804-282-1046
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166271363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care