Basic Information
| Provider Information | |||||||||
| NPI: | 1750759833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLACK | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043164460 | ||||||||
| FaxNumber: | 7043164466 | ||||||||
| Practice Location | |||||||||
| Address1: | 7903 PROVIDENCE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043164460 | ||||||||
| FaxNumber: | 7043164466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2015 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 20068 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 5007948 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.