Basic Information
| Provider Information | |||||||||
| NPI: | 1770764789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTWELL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 CAMPUS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242109700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767398010 | ||||||||
| FaxNumber: | 2766251410 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 CAMPUS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242109700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767398010 | ||||||||
| FaxNumber: | 2766251410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2007 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0110002632 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 1625 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1770764789 | 05 | VA | MEDICAID | 1509053 | 05 | TN | MEDICAID |