Provider Demographics
NPI:1811650286
Name:KIRK, MELISSA FAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAYE
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 BECKFORD ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8156
Mailing Address - Country:US
Mailing Address - Phone:843-617-8071
Mailing Address - Fax:
Practice Address - Street 1:401 E CHEVES ST STE 202
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2615
Practice Address - Country:US
Practice Address - Phone:843-777-7863
Practice Address - Fax:843-777-7873
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily