Provider Demographics
NPI:1245081314
Name:MCCLELLAN, MELISSA SMITH
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SMITH
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GOLF COURSE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5291
Mailing Address - Country:US
Mailing Address - Phone:828-803-5061
Mailing Address - Fax:
Practice Address - Street 1:315 GOLF COURSE RD APT 205
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5291
Practice Address - Country:US
Practice Address - Phone:828-803-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1142334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist