Provider Demographics
NPI:1518365899
Name:MEADOR, MELISSA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:MEADOR
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:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-471-2273
Mailing Address - Fax:843-377-8180
Practice Address - Street 1:8761 DORCHESTER RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7321
Practice Address - Country:US
Practice Address - Phone:843-471-2273
Practice Address - Fax:843-377-8180
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3417Medicaid
SCSC5555A634Medicare PIN