Provider Demographics
NPI:1417438839
Name:WRIGLESWORTH, MELISSA DIANE (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:WRIGLESWORTH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5070
Mailing Address - Fax:704-316-5075
Practice Address - Street 1:9604 HOLLY POINT DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4913
Practice Address - Country:US
Practice Address - Phone:704-316-5070
Practice Address - Fax:704-316-5075
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty