Individual
MEGEN YATES MELLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2013 JEFFERSON ST SW, ROANOKE, VA 24014-2419
(540) 981-7377
Mailing address
2013 JEFFERSON ST SW, ROANOKE, VA 24014-2419
(540) 981-7377
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024179583
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024179583
FNP LICENSE
VA
Enumeration date
06/30/2020
Last updated
06/30/2020
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