Provider Demographics
NPI:1245209543
Name:HERRINGTON, MELISSA ANN CLARK (PA- C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN CLARK
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7400 CARMEL EXECUTIVE PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8518
Mailing Address - Country:US
Mailing Address - Phone:980-247-1543
Mailing Address - Fax:
Practice Address - Street 1:7400 CARMEL EXECUTIVE PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8518
Practice Address - Country:US
Practice Address - Phone:980-247-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245209543Medicaid
S87133Medicare UPIN
NC897813AMedicaid
NC2751962CMedicare UPIN