Provider Demographics
NPI:1144313172
Name:BEVINS, MELISSA HAIKAL (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HAIKAL
Last Name:BEVINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:HAIKAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-971-7099
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:10710 SIKES PL STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8194
Practice Address - Country:US
Practice Address - Phone:704-248-5101
Practice Address - Fax:704-482-5120
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1009PAMedicaid
SC1009PAMedicaid
NC2762402Medicare PIN
NC2762402Medicare PIN