Provider Demographics
NPI:1508642547
Name:MELTON, JACQUELYN ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELYN
Middle Name:ELIZABETH
Last Name:MELTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W CARY ST APT 408
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5414
Mailing Address - Country:US
Mailing Address - Phone:804-380-8567
Mailing Address - Fax:
Practice Address - Street 1:805 W CARY ST APT 408
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5414
Practice Address - Country:US
Practice Address - Phone:804-380-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily