Provider Demographics
NPI:1629180849
Name:KELLY, MELISSA D (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE. 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:802 GREEN VALLEY RD
Practice Address - Street 2:STE. 210
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7041
Practice Address - Country:US
Practice Address - Phone:336-510-5510
Practice Address - Fax:336-810-5515
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9169528163WP0200X
NC5008997363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307942200Medicaid