Provider Demographics
NPI:1407070295
Name:DOYLE, MELISSA B (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:DOYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4104
Mailing Address - Country:US
Mailing Address - Phone:910-255-4329
Mailing Address - Fax:
Practice Address - Street 1:354 WAGONER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3498
Practice Address - Country:US
Practice Address - Phone:910-491-1727
Practice Address - Fax:910-835-2155
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004049Medicaid
NC5003013OtherRN LICENSE
Q54170Medicare UPIN
2852025Medicare PIN