Provider Demographics
NPI:1679050249
Name:WILLIAMS, MELANIE KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KATHERINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 CORALBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9737
Mailing Address - Country:US
Mailing Address - Phone:919-757-8284
Mailing Address - Fax:
Practice Address - Street 1:100 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1604
Practice Address - Country:US
Practice Address - Phone:252-522-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty