Provider Demographics
NPI:1841398690
Name:CARTER, MELISSA JEWELL (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEWELL
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEWELL
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-CNM
Mailing Address - Street 1:2221 NORTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8990
Mailing Address - Country:US
Mailing Address - Phone:863-421-7600
Mailing Address - Fax:863-421-7551
Practice Address - Street 1:2221 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8990
Practice Address - Country:US
Practice Address - Phone:863-421-7600
Practice Address - Fax:863-421-7551
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9410717363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100119860AMedicaid