Provider Demographics
NPI:1295341667
Name:MEALEY, NICOLE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:MEALEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 CORDOBA CIR APT 206
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-2540
Mailing Address - Country:US
Mailing Address - Phone:607-244-2929
Mailing Address - Fax:
Practice Address - Street 1:2909 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1221
Practice Address - Country:US
Practice Address - Phone:910-687-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant