1164824793 NPI number — MELISSA WEST

Table of content: MELISSA WEST (NPI 1164824793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164824793 NPI number — MELISSA WEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOUSE
Provider Other First Name:
MELISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164824793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/29/2021
NPI Reactivation Date:
06/12/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4746 GARDENIA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-9500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-883-1789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 FAIRWAY DR., BUTTERFLY EFFECTS LLC,
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-880-9270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)