Provider Demographics
NPI:1699001651
Name:MCCUTCHAN, MELISSA JEAN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JEAN
Last Name:MCCUTCHAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:LEAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:105 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-797-7060
Practice Address - Fax:864-797-7065
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26565363LA2100X
TN24250363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24250OtherSTATE LICENSE
SCPENDINGMedicaid