Provider Demographics
NPI:1912768219
Name:CARTRETTE, MELISSA SUE (AGNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:CARTRETTE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:WILLIS
Other - Last Name:CARTRETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-0597
Mailing Address - Country:US
Mailing Address - Phone:912-685-1720
Mailing Address - Fax:
Practice Address - Street 1:10 DOCTORS ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3337
Practice Address - Country:US
Practice Address - Phone:912-685-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235533363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology