Provider Demographics
NPI:1639640949
Name:MELENDEZ, KARI (NP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:NP
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 419402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9402
Mailing Address - Country:US
Mailing Address - Phone:855-290-1552
Mailing Address - Fax:866-787-9747
Practice Address - Street 1:1101 SAM PERRY BLVD STE 414
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4466
Practice Address - Country:US
Practice Address - Phone:540-899-1354
Practice Address - Fax:540-899-1359
Is Sole Proprietor?:No
Enumeration Date:2018-12-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019785207R00000X, 363L00000X
VA0024179749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024179749OtherSTATE LICENSE
PASP019785OtherSTATE LICENSE