Provider Demographics
NPI:1477815942
Name:MCCOMAS, MELISSA DENAE (RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DENAE
Last Name:MCCOMAS
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 WASHINGTON ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2511
Mailing Address - Country:US
Mailing Address - Phone:304-414-5930
Mailing Address - Fax:
Practice Address - Street 1:1520 WASHINGTON ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2511
Practice Address - Country:US
Practice Address - Phone:304-414-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2012007762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily