Provider Demographics
NPI:1316514920
Name:BLACK, MELISSA WHITESELL (CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:WHITESELL
Last Name:BLACK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HANDLEY PARK CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1769
Mailing Address - Country:US
Mailing Address - Phone:919-734-3344
Mailing Address - Fax:
Practice Address - Street 1:1124 GALLERY PARK LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1142
Practice Address - Country:US
Practice Address - Phone:910-343-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC796367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife