Provider Demographics
NPI:1891216164
Name:KEITH, MELANIE LOUISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LOUISE
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LOUISE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 TRADERS WAY APT 30113
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1387
Mailing Address - Country:US
Mailing Address - Phone:520-256-3126
Mailing Address - Fax:
Practice Address - Street 1:19 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1705
Practice Address - Country:US
Practice Address - Phone:617-865-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10284363LF0000X
MARN2389822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily