1184609752 NPI number — MRS. TAMMY LYNNE JOHNSON MELTON FNP-C

Table of content: MRS. TAMMY LYNNE JOHNSON MELTON FNP-C (NPI 1184609752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184609752 NPI number — MRS. TAMMY LYNNE JOHNSON MELTON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON MELTON
Provider First Name:
TAMMY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELTON
Provider Other First Name:
TAMMY
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184609752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6324 FAIRVIEW RD STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-302-8680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2005

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: 163W00000X , with the licence number:  90293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 201712 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 201712 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 611186890 . This is a "611186890" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5950066 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611186890 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP0682 . This is a "SC MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012U9 . This is a "BCBS NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "CRESENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: C4367 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7003522 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0171701 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "HUMANA/TRICARE" identifier . This identifiers is of the category "OTHER".




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