Provider Demographics
NPI:1013267558
Name:FOWLER, MELONY C (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:C
Last Name:FOWLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELONY
Other - Middle Name:C
Other - Last Name:SCARBOROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 620
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-573-7511
Practice Address - Fax:864-560-1690
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006590Medicaid
SCP01172085OtherRAILROAD MEDICARE
SCNP2131Medicaid
SCNP2131Medicaid
SCAA99585206Medicare PIN