Basic Information
| Provider Information | |||||||||
| NPI: | 1295304301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELVIN | ||||||||
| FirstName: | TEVA | ||||||||
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| Credential: | CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15 | ||||||||
| Address2: | |||||||||
| City: | STEDMAN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283910015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103226740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1738 OWEN DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107388060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2021 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | MELV-A6W7R | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.