Individual
MRS. TAMMY LYNNE JOHNSON MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
6324 FAIRVIEW RD STE 310, CHARLOTTE, NC 28210-4172
(980) 302-8680
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
90293
NC
363L00000X
Nurse Practitioner
Primary
201712
NC
363LF0000X
Family Nurse Practitioner
201712
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012U9
BCBS NC
—
01
—
0171701
UNITED HEALTHCARE
—
05
—
5950066
—
NC
01
—
611186890
611186890
—
05
—
7003522
—
NC
01
—
C4367
MEDCOST
—
01
—
NP0682
SC MEDICAID
—
Enumeration date
12/07/2005
Last updated
03/26/2021
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