Provider Demographics
NPI:1336858166
Name:OGBURN, MELANIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:OGBURN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MONTICELLO AVE
Mailing Address - Street 2:STE 1802 PMB 715264
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1146
Mailing Address - Country:US
Mailing Address - Phone:540-209-9778
Mailing Address - Fax:
Practice Address - Street 1:440 MONTICELLO AVE
Practice Address - Street 2:STE 1802 PMB 715264
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1146
Practice Address - Country:US
Practice Address - Phone:540-209-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114901363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health