Provider Demographics
NPI:1184093320
Name:FORREST, MELINDA CROUCH (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:CROUCH
Last Name:FORREST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1320
Mailing Address - Country:US
Mailing Address - Phone:803-265-2015
Mailing Address - Fax:803-708-0865
Practice Address - Street 1:401 W MARTINTOWN RD
Practice Address - Street 2:SUITE 140
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3186
Practice Address - Country:US
Practice Address - Phone:803-265-2015
Practice Address - Fax:803-708-0865
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily