Provider Demographics
NPI:1669025763
Name:PERRY, MELISA WALLACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:WALLACE
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:218 FOUST ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5476
Mailing Address - Country:US
Mailing Address - Phone:336-625-2333
Mailing Address - Fax:336-625-5511
Practice Address - Street 1:514 N BROAD ST
Practice Address - Street 2:
Practice Address - City:SEAGROVE
Practice Address - State:NC
Practice Address - Zip Code:27341
Practice Address - Country:US
Practice Address - Phone:336-873-8045
Practice Address - Fax:336-873-9074
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5012013363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner