Provider Demographics
NPI:1104505650
Name:CUNNINGHAM, MELODY KEYONN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:KEYONN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 COBB PKWY NW APT 5112
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6562
Mailing Address - Country:US
Mailing Address - Phone:770-634-4134
Mailing Address - Fax:
Practice Address - Street 1:3050 COBB PKWY NW APT 5112
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6562
Practice Address - Country:US
Practice Address - Phone:770-634-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily