Individual
MRS. MELISSA MICHELLE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
222 E MEDICAL LN STE 100&200, WEST COLUMBIA, SC 29169-4847
(803) 935-8410
(803) 936-7816
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
17870
SC
Other
Enumeration date
06/21/2012
Last updated
10/13/2020
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