Provider Demographics
NPI:1285481960
Name:RICHARDSON, MELANIE KATRIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KATRIN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N GLENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7324
Mailing Address - Country:US
Mailing Address - Phone:910-639-4394
Mailing Address - Fax:
Practice Address - Street 1:1000 SOCIAL ST STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2102
Practice Address - Country:US
Practice Address - Phone:980-880-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029175363L00000X
NC5019772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner