Provider Demographics
NPI:1528414612
Name:WAYNE, MELISSA BUCKNER (NP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BUCKNER
Last Name:WAYNE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ASHLEY
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2716 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2489
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-251-0421
Practice Address - Street 1:5160 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4012
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-332-3833
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008560363L00000X
NC238638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse