Provider Demographics
NPI:1295813251
Name:WILKINSON, MELODY R (FNP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:R
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 HEDGEMORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3237
Mailing Address - Country:US
Mailing Address - Phone:704-331-9669
Mailing Address - Fax:704-688-0035
Practice Address - Street 1:4539 HEDGEMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3237
Practice Address - Country:US
Practice Address - Phone:704-331-9669
Practice Address - Fax:704-688-0035
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24165284363LF0000X
NC5003908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7793596Medicaid
VA7793596Medicaid
VAP75180Medicare UPIN
NC2593416Medicare PIN