Provider Demographics
NPI:1689844730
Name:PARIS, MELISSA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:PARIS
Suffix:
Gender:F
Credentials:PA
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6235 BLAKENEY PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5658
Practice Address - Country:US
Practice Address - Phone:704-512-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01287363A00000X
NC001001287363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1780911339Medicaid
SCNPB716Medicaid
NC1194052761Medicaid
NC1538495767Medicaid
NC8102097Medicaid
SCNPB113Medicaid
SCNPB252Medicaid
NC1710914171Medicaid
SCNPB114Medicaid
NC1780911339Medicaid